THE  LIBRARY 

OF 

THE  UNIVERSITY 
OF  CALIFORNIA 

PRESENTED  BY 

PROF.  CHARLES  A.  KOFOID  AND 
MRS.  PRUDENCE  W.  KOFOID 


MALARIA: 

WHAT  IT  MEANS  AND  How  AVOIDED. 


OTHER  BOOKS  BY 

DR.  JOSEPH  F.  EDWARDS. 


How  a  Person  Threatened  or  Afflicted 
with  Bright's  Disease  Ought  to  Live. 

i2mo.     Cloth.     Price  750. 

Constipation  Plainly  Treated  without  the 
use  of  Drugs.  Second  Edition,  with^addi- 
tions.  i2mo.  Cloth.  Price  75c. 

Dyspepsia,  and  How  to  Avoid  It.  Just 
issued.  i2mo.  Cloth.  Price  75c. 

Sent  to  any  address,  postage  paid,  upon  receipt 
of  the  price. 

PRESLEY  BLAKISTON, 
No,  1O12   WALNUT  STREET, 

PHILADELPHIA. 


MALARIA: 


WHAT   IT   MEANS 


HOW  AVOIDED. 


JOSEPH  F.  EDWARDS,  M.D., 

AUTHOR    OF  "HOW  A    PERSON    THREATENED    OR    AFFLICTED    WITH 
BRIGHT'S  DISEASE  OUGHT  TO  LIVE/'  "  CONSTIPATION  PLAINLY 

TREATED    AND    RELIEVED   WITHOUT   THE   USE   OF    DRUGS," 
"  DYSPEPSIA,    HOW   TO    AVOID   IT,"    ETC. 


PHILADELPHIA: 

PRESLEY   BLAKISTON, 

1012  WALNUT  STREET. 

1881. 


Entered  according  to  Act  of  Congress,  in  the  year  1881,  by 

PRESLEY  BLAKISTON, 
In  the  Office  of  the  Librarian  of  Congress  at  Washington,  D.  C. 


Press  of  WM.  F.  FELL  &  Co., 

1220-1224  SANSOM  ST., 

PHILADELPHIA. 


-  RC  75*6 


CONTENTS. 


PREFACE, 7 

WHAT  is  MALARIA, 9 

WHERE  is  MALARIA  FOUND, 28 

SYMPTOMS  OR  SIGNS  OF  MALARIA,    .     .     .     .  58 

How  TO  AVOID  MALARIA, 63 


PREFACE. 


Of  all  preventable  diseases,  of  all  human  suffer- 
ing that  can  be  avoided  by  a  litttle  general  knowl- 
edge, the  myriads  of  symptoms  ascribed  to  mala- 
ria stand  pre-eminently  high.  Of  all  affections 
about  which  public  misapprehension  is  very  great, 
malaria  is  entitled  to  the  highest  rank.  Of  all 
unsatisfactory  terms,  this  title  of  malaria  is  by  far 
the  most  unsatisfactory.  Whenever  a  person  feels 
out  of  sorts,  biliousness  or  malaria  receives  the 
blame.  This  term  is  made  the  shield  by  many  in- 
competent physicians,  to  hide  their  want  of  pene- 
tration in  diagnosis,  and  is  accepted  by  the  patient 
as  the  true  cause  of  all  his  suffering.  This  gene- 
ral belief  in  the  great  pre valance  of  malaria  and 
the  public  notion  that  quinine  is  a  specific  for  the 
disease  in  all  its  forms,  has  caused  the  unintelligent 
use  of  enormous  quantities  of  quinine  by  an  un- 
advised and  uninstructed  public,  much  to  the 
vii 


Vlll  PREFACE. 

general  detriment  of  the  human  race.  In  mala- 
ria, probably  more  than  in  any  other  disordered 
state  of  the  system,  an  ounce  of  prevention  is  worth 
a  pound  of  cure.  Therefore  it  seems  to  me,  that 
mankind  can  be  improved  in  general  health  and 
benefited  physically,  by  a  better  understanding 
of  the  true  nature  of  malaria  and  the  best  means 
of  avoiding  it. 

JOSEPH  F.  EDWARDS. 

Saint  George  Hotel, 

Broad  and  Walnut  Sts.,  Philadelphia, 

September,  1881. 


WHAT  IS  MALARIA? 


I  have  undertaken  a  herculean  task,  when  I 
attempt  to  answer  this  question.  So  diverse  are 
the  views  entertained  on  this  subject,  and  so  com- 
paratively meagre  the  accurate  knowledge  which 
we  possess,  that  it  will  be  a  very  difficult  matter 
to  give  an  explanation  of  the  nature  of  malaria 
that  will  be  universally  satisfactory;  so  that,  while 
I  feel  sure  that  the  views  expressed  in  this  chapter 
will  receive  some  rough  handling  and  severe  criti- 
cism, yet  I  am  equally  certain  that  what  I  will 
tell  you  will  be  the  means  of  enabling  you  to 
avoid  very  much  of  the  suffering  which  is  directly 
or  indirectly  traceable  to  malaria.  There  was  a 
time  when  the  name  malaria  was  applied  to  a  cer- 
tain specific  poison,  which  possessed  the  power  of 
producing  Intermittent  Fever,  Chills  and  Fever, 
Ague.  Thus  Professor  Flint,  of  New  York,  in 
the  third  edition  of  his  Practice  of  Medicine,  pub- 
lished in  1868,  says,  "  The  causation  "  (of  Inter- 
mittent Fever)  "  involves  a  special  morbific  agent, 
commonly  known  as  malaria."  In  1717,  Lan- 
cisci,  an  Italkn  writer,  called  this  special  poison 
B  9 


10  WHAT    IS    MALARIA? 

marsh  miasm,  and  described  its  origin  as  due  to 
vegetable  decomposition.  In  Dunglison's  Medi- 
cal Dictionary,  published  in  1868,  malaria  is  de- 
fined as  follows :  ' '  The  word  miasm  (malaria) 
has  by  some  been  employed  synonymously  with 
contagion.  It  is  now  used  more  definitely  for  any 
emanation,  either  from  the  bodies  of  the  sick,  or 
from  animal  and  vegetable  substances,  or  from 
the  earth,  especially  in  marshy  districts,  which 
may  exert  a  morbid  influence  on  those  exposed  to 
its  action.  To  these  terrestrial  emanations  the 
Italians  give  the  name  aria  cattiva,  but  more  com- 
monly, malaria  (bad  air).  Of  the  miasm  which 
arises  either  from  the  animal  body  or  from  the 
most  unhealthy  situations,  we  know,  chemically, 
nothing.  All  that  we  do  know  is,  that  under 
such  circumstances  emanations  take  place,  capable 
of  causing  disease  in  many  of  those  who  are  ex- 
posed to  their  action." 

A  very  indefinite  definition,  but  as  accurate  as 
any  that  have  hitherto  been  offered  in  our  present 
limited  knowledge  of  the  exact  nature  of  these  poi- 
sonous emanations.  In  his  "Practical Hygiene" 
Dr.  Parkes,  the  late  eminent  English  sanitarian, 
says,  ' '  The  most  important  organic  impurity  of 
the  atmosphere  is  malaria."  Dr.  F.  T.  Roberts,  in 
his  Practice  of  Medicine,  says,  "  Certain  other  dis- 
eases are  attributed  to  it  (malaria),  such  as  dysen- 
tery, diarrhoea,  gastric  disturbance,  etc.,  and  also 


WHAT    IS    MALARIA?  11 

a  general  state  of  ill  health  and  low  cachexia,  with 
ultimate  degeneration  of  the  race. ' '  He  also  tells 
us  that  ' '  The  essential  conditions  for  the  produc 
tion  of  the  malarial  poison  are,  vegetable  decom- 
position, a  certain  temperature,  with  a  certain  de- 
gree of  moisture. ' '  You  can  now  understand  how 
much  uncertainty  exists  concerning  the  true  nature 
of  malaria.  Until  we  accumulate  exact  informa- 
tion on  any  subject,  theorizing  is  not  only  permis- 
sible, but,  by  giving  us  a  platform  upon  which  to 
conduct  our  experimental  researches,  becomes  a 
very  important  factor  in  the  accumulation  of  this 
knowledge,  provided  always,  that  we  do  not  rest 
content  with  the  mere  theory,  but  accept  it  as  a  fact 
only  when  it  has  been  indubitably  proven  to  be 
such  by  the  crucial  test  of  the  severest  scrutiny, 
the  most  intimate  research  and  the  weight  of 
overwhelming  experience.  Therefore,  premising 
that  what  I  am  about  to  say  is  only  theory,  and 
warning  you  against  regarding  my  theories  as 
facts,  until  they  have  been  amply  proven  to  be 
such,  I  will  conduct  you  through  a  process  of  rea- 
soning, by  which  I  hope  to  make  it  seem  at  least 
probable  that  the  origin  and  true  nature  of  ma- 
larial poison,  as  we  now  call  it,  has  been  shrouded 
in  unnecessary  mystery,  thus  preventing  us  from 
comprehending  its  true  nature,  and  at  the  same 
time,  that  the  term  malaria  is  improperly  applied. 
Even  if  I  do  not  succeed  in  theoretically  estab- 


12  WHAT    IS    MALARIA? 

lishing  my  position,  at  any  rate,  there  can  be  no 
question  but  that  the  information  I  will  give  you, 
if  properly  utilized,  will  be  productive  of  very 
much  physical  good.  These  few  words  of  expla- 
nation I  have  deemed  necessary,  because,  as  this 
book  is  more  especially  intended  for  the  non-pro- 
fessional public  it  becomes  imperative  that  I  should 
exercise  the  greatest  care  not  to  mislead  them,  nor 
to  give  them  erroneous  ideas,  nor  to  cause  them 
to  accept  as  settled  fact  that  which  is  in  doubt. 
Therefore,  I  again  say,  the  reasoning  I  will  now 
furnish  is  my  own,  the  ideas  I  will  give  are 
my  own  ;  whatever  is  to  blame  in  them  or  to  com- 
mend, I  alone,  and  not  my  profession,  am  respon- 
sible for.  The  profession  recognizes  the  uncer- 
tainty of  our  knowledge  concerning  the  malarial 
poison,  and  speaks  of  it  in  doubtful  and  uncertain 
terms ;  I  also  recognize  this  uncertainty,  but  I  am 
at  the  same  time  endeavoring  to  erect  a  theoretical 
framework,  to  be  filled  in  with  the  accumulations 
of  research  and  experience,  until  either  a  clear  case 
is  made  out  for  my  theory,  order  springs  from  the 
present  chaotic  notions  of  malaria,  and  from  un- 
certainty we  possess  a  certain  and  accurate  knowl- 
edge of  the  nature  and  origin  of  malarial  poison, 
or,  on  the  other  hand,  my  theory  dies  for  want 
of  experimental  support,  and  sinks  out  of  sight 
unsupported  by  the  research  and  experience  of 
observers.  Medical  readers  will  now  understand 


WHAT    IS    MALARIA?  13 

my  position  and  non-professional  persons  will  be 
prevented  from  falling  into  the  error  of  accepting 
a  theory  as  an  admitted  fact,  by  the  explanation 
I  have  made.  Now  to  our  reasoning.  In  the  first 
place,  let  us  examine  whether  the  term  malaria  is 
properly  applied.  In  my  opinion  it  has  not  been, 
and  is  not.  Its.application  is  too  liberal  and  hence 
has  been  misleading.  In  a  more  restricted  sense,  it  is 
an  eminently  appropriate  and  expressive  terni,  and 
its  nature  can  be  much  more  readily  comprehended. 
The  word  malaria  has  been  derived  from  the  two 
words  mal  aria,  bad  air,  and  considering  its 
derivation,  its  present  broad  application  is  entirely 
too  broad,  and  is  calculated  ,to  leave  its  exact 
nature  forever  in  doubt,  since  it  necessitates  the 
impossible  achievement  of  tracing  too  many  effects 
to  the  same  cause.  The  word  miasm  has  a  different 
origin,  being  derived  from  the  Greek,  tua<;p.a,  a 
stain  from  /jLiatow,  I  contaminate.  Now,  although 
Dunglison  in  his  medical  dictionary  refers  the  defini- 
tion of  the  word  malaria  to  miasm  or  miasma,  and 
so  confounds  the  two  and  makes  them  identical  in 
their  meaning,  yet  it  will  be  seen,  from  their  deri- 
vation, by  the  meaning  of  the  parent  words  from 
which  they  have  been  formed,  that  they  are  dis- 
tinct. While  malaria  really  means  bad  air,  and 
is  a  comprehensive  term  for  atmospheric  impuri- 
ties of  various  kinds ;  miasma  conveys  the  idea  of 
an  effect  and  not  a  cause ;  it  is  a  stain,  a  contami- 


14  WHAT    IS    MALARIA? 

nation  of  some  portion  of  the  human  body,  which 
contamination  must  be  the  result  of  some  causative 
action.  Hence  the  terms  malaria  and  miasma, 
which  are  generally  used  synonymously,  are  not 
only  not  the  same  in  meaning,  but  the  only  rela- 
tion that  they  can  possibly  hold  to  each  other  is 
that  of  cause  and  effect,  the  malaria  or  bad  air 
being  the  cause  and  the  miasma  or  contamination 
the  effect  of  this  cause.  Here,  then,  we  see  one 
important  error  in  the  application  of  the  word 
malaria.  Again,  nearly  all  medical  writers  tell 
us,  as  Professor  Flint  has  done,  that  the  causation 
of  intermittent  fever,  chills  and  fever,  ague,  etc., 
involves  a  special  morbific  agent,  commonly 
known  as  malaria.  Had  they  said  a  special  mor- 
bific agent  commonly  believed  to  constitute  one  of 
the  elements  of  malaria,  they  would  have  been  at 
least  more  accurate.  Since  malaria  really  means 
bad  air,  this  causative  influence  of  malaria  on 
Chills  and  Fever  is  evidently  exaggerated  and 
misinterpreted,  since  bad  air  will  not  in  every 
instance  give  rise  to  intermittent  fever,  simply 
because  the  air  is  bad ;  in  order  to  produce  the 
characteristic  symptoms  of  this  disease,  the  mala- 
rial poison  or  bad  air  must  contain  some  particu- 
lar deleterious  agent,  capable  of  producing  these 
characteristic  symptoms,  and  without  the  pres- 
ence of  which  they  are  not  developed,  no  matter 
how  bad  and  impure  the  air  may  be.  There- 


WHAT    IS    MALARIA?  15 

fore  it  would  seem  that  the  application  of  the 
term  malaria  had  become  entirely  too  compre- 
hensive, since  the  poisoned  condition  of  the 
atmosphere  which  is  generally  indicated  when  we 
say  bad  air,  cannot  of  itself  alone  produce  the 
phenomena  of  Intermittent  Fever,  which  depend 
for  their  existence  on  the  presence  of  a  special 
poisonous  element  in  this  bad  air.  To  illustrate 
this  point,  that  the  presence  of  the  special  poison 
of  Intermittent  Fever  is  necessary  in  the  atmos- 
phere, in  order  that  this  disease  may  be  developed, 
I  will  quote  from  the  July  bulletin  of  the  Secretary 
of  the  Connecticut  State  Board  of  Health,  which 
says, . ' '  Malarial  diseases  appear  to  have  taken  a 
step  eastward  and  northward,  as  a  death  from 
malarial  fever  is  reported  from  Norwich.  I  have 
not  yet  learned  of  any  east  of  the  Thames  river. 
In  many  places  they  are  reported  as  increasing, 
as  in  Bloomfield,  New  Canaan,  Unionville,  and 
other  towns  in  various  parts  of  the  State,  while 
others  report  decrease,  as  in  Clinton  and  Guil- 
ford.  Collinsville  claims  entire  exemption  from 
malaria  in  every  form,  unless  imported,  as  thus  far 
no  cases  have  originated  there.  If  flowing  large 
areas  and  alternately  covering  and  exposing  the 
bed  of  the  pond  produced  malaria,  we  should  have 
it  here.  If  vegetable  decay  alone  produces  it, 
we  should  have  a  fearful  epidemic  at  this  Po- 
quonnoc  Bridge,  instead  of  Scarlet  Fever,  as  the 


16  WHAT    IS    MALARIA? 

river  was  absolutely  choked  with  vegetable  sub- 
stances, decaying,  and  alternately  covered  and  ex- 
posed. Yet  no  case  of  malaria  has  ever  originated 
in  this  town"  In  this  communication  the  Sec- 
retary of  the  State  Board  of  Health  does  not 
mean  what  I  do,  and  am  endeavoring  to  make  you, 
understand  by  the  term  malaria.  He  clearly  re- 
fers to  some  one  of  the  forms  of  Intermittent 
Fever,  as  nearly  all  writers  now  do.  You  will 
observe  that  he  shows  many  causes  for  air  im- 
purity, for  malaria  or  bad  air,  yet  he  says  that  no 
cases  of  malaria,  of  his  malaria,  have  originated 
there.  Yet  my  malaria,  bad  air,  surely  would  be 
found  there;  but  the  special  poison  capable  of 
producing  Intermittent  Fever  was  wanting.  So 
that  it  is  entirely  too  liberal  to  ascribe  the  produc- 
tion of  Chills  and  Fever  to  Malaria  in  its  true 
sense.  Smallpox  is  caused  either  by  the  inhalation 
from  the  surrounding  atmosphere  of  a  particular 
poison  capable  of  producing  this  disease,  or  by  the 
reception  of  this  poison  from  the  closer  contact 
of  a  person  already  afflicted  with  the  disease.  In 
either  case  the  air  acts  as  the  medium  of  commu- 
nication. Typhoid  Fever  is  caused,  in  many 
cases,  by  sewer  gas;  this  impurity  contaminates 
the  air  we  breathe,  and  so  entering  the  body  gives 
rise  to  this  particular  disease.  Cholera  is  likewise 
propagated.  The  same  is  true  of  all  the  infec- 
tious diseases.  Now  the  air  which  is  capable  of 


WHAT    IS    MALARIA?  1.7 

giving  rise  to  Smallpox,  Typhoid  Fever,  Cholera, 
and  the  like,  surely  must  be  mal  aria;  it  must  of 
necessity  be  bad  and  impure  air,  since  it  contains 
noxious  elements  capable  of  producing  a  diseased 
condition  of  the  human  body,  which  elements  do 
not  exist  in  pure  air.  Therefore,  since  malaria 
really  means  nothing  more  than  bad  or  impure 
air,  is  it  not  misleading  and  confusing  to  speak  of 
malaria  as  the  cause  of  intermittent  fever,  as  the 
active  agent  in  the  production  of  chills  and  fever  ? 
Does  it  not  seem  more  correct  to  hold  the  view 
that  malaria  means  simply  impure  air,  rendered 
unwholesome  by  the  presence  of  a  great  variety  of 
impure  elements,  which  elements  are  capable  of 
producing  various 'disordered  and  unhealthy  con- 
ditions of  the  system  ?  In  one  instance  the  im- 
purity may  be  of  such  a  nature  as  to  give  rise  to 
the  phenomena  of  chills  and  fever,  in  another  to 
cholera,  in  a  third  to  smallpox,  in  a  fourth  to 
diphtheria,  and  so  on ;  but  that  in  each  case  it  is 
absolutely  necessary  that  the  special  impurity 
should  be  present  to  give  rise  to  the  special  dis- 
ease, which  cannot  be  produced  merely  by  the  in- 
halation of  foul  air  in  which  this  particular  special 
impurity  does  not  exist.  It  would,  therefore,  be 
more  proper  to  speak  of  the  poison  of  Smallpox, 
of  Typhoid  Fever,  of  Dysentery,  of  Chills  and 
Fever,  as  elements  of  malaria  or  of  impure  air,  if 
we  desire  to  bring  malaria  into  a  causative  relation 


18  WHAT    IS    MALARIA? 

with  these  diseases  at  all.  This  is  not,  however, 
my  intention.  It  will  be  better  and  will  cause  less 
misunderstanding  and  confusion,  if  we  speak  of 
the  poison  of  Smallpox,  of  Dysentery,  Chills  and 
Fever,  and  so  on,  and  leave  malaria  entirely  out 
of  consideration.  Let  us  endeavor  to  form  an 
accurate  view  of  this  very  popular  word,  and  to 
have  a  definite  idea  of  its  meaning.  The  use 
which  has  been  and  is  made  of  this  word  is  truly 
ridiculous.  The  very  fact  that  it  has  been  util- 
ized to  designate  so  many  diverse  conditions, 
plainly  indicates  the  indefinite  and  uncertain 
views  of  its  true  nature  and  properties  which  have 
been  and  are  entertained  alike  by  the  Medical 
Profession  and  the  general  public.  Superficial 
physicians,  when  baffled  by  the  intricacies  of  an 
obscure  chronic  case  of  disease,  fearing  to  confess 
their  inability  to  penetrate  the  difficulties  of  the 
case,  and  make  a  correct  diagnosis,  lest  their 
honest  confession  may  cost  them  their  patient, 
fall  back  upon  this  mysterious  malaria,  and  their 
patients  having  a  very  vague  and  visionary  notion 
of  the  nature  of  this  wonderful  affection,  accept 
the  diagnosis,  and  another  case  of  malaria  is 
added  to  the  already  immensely  long  list  of  cases 
of  this  hydra-headed  disease.  The  medical  pro- 
fession are  commencing  to  realize  the  absurd  and 
ridiculous  position  which  this  undefined  word  occu- 
pies, and  our  medical  journals  now  contain  many 


WHAT    IS    MALARIA?  19 

articles  on  the  subject,  some  ridiculing  the  preva- 
lent ideas  concerning  it,  while  others  are  seriously 
endeavoring  to  find  a  proper  place  and  mean- 
ing for  it.  Some  of  the  most  wonderful  and 
apparently  most  mysterious  tricks  performed  by 
the  great  magicians,  are,  when  explained,  exceed- 
ing simple  and  easy  of  performance.  It  is  their 
very  simplicity  that  saves  them  from  detection. 
Apparently  wonderful,  it  seems  to  the  uninitiated 
that  they  must  be  very  difficult  of  comprehension, 
and  a  laborious  process  of  thought  and  reasoning 
fails  to  elucidate  them,  while,  when  understood, 
one  is  ashamed  of  his  former  obtuseness,  and 
wonders  how  he  could  have  been  so  stupid  as  not 
to  penetrate  such  an  obvious  and  childish  trick. 
So  it  is  with  many  more  serious  questions.  Man 
seems  determined  to  mystify  himself.  Instead  of 
endeavoring  (where  possible)  to  explain  the  phe- 
nomena of  nature  as  easily  as  possible,  he  seems 
to  think  it  necessary  to  surround  his  investigations 
with  all  the  difficulties  and  obstructions  that  he 
can  possibly  invent.  Imagining  that  everything 
which  he  does  not  already  know  concerning 
nature's  workings  and  scientific  truths  must  be 
very  obscure,  and  can  be  elucidated  only  by  the 
most  profound  and  circuitous  reasoning,  he  fails 
to  try  first  to  explain  them  by  simple,  practical 
common  sense,  but  straightway  rushes  into  scien- 
tific theorizing  of  the  most  sublime  character,  and 


20  WHAT    IS    MALARIA? 

interprets  every  ordinary  occurrence  of  nature,  not 
through  the  eye  of  common  sense,  but  views  it  with 
the  high  power  microscope  of  science.  As  a 
result,  many  things  are  shrouded  with  mystery 
and  but  imperfectly  comprehended  simply  because 
a  tremendous  effort  is  made  to  understand  them, 
instead  of  explaining  them  in  a  simple,  practical, 
common  sense,  matter-of-fact  way.  This  point  is 
particularly  true  of  the  question  under  consider- 
ation. There  is  nothing  wonderful  or  mysterious 
about  malaria.  No  deep  reasoning  or  intimate 
scientific  research  is  necessary  to  comprehend  its 
nature.  If  properly  viewed,  its  nature  is  as  clear 
as  the  clearest  spring  water.  What,  then,  is  the 
nature,  what  are  the  properties  of  this  much- 
abused  word  ?  Simply  what  the  word  means.  I 
have  already  told  you  that  malaria  is  derived 
from  two  words,  mal,  bad,  and  aria,  air  ;  put  them 
together  and  you  have  a  perfect  definition  of  this 
hitherto  mystic  word,  malaria,  which  does  mean, 
and  can  mean,  nothing  more  nor  less  than  bad  air. 
Let  us  do  away  with  all  the  uncertainty  surround- 
ing this  word,  and  comprehend  it  properly.  Do 
not  let  us  any  longer  say  that  Chills  and  Fever 
are  produced  by  malaria  (bad  air),  that  Typhoid 
Fever  is  due  to  malaria  (bad  air),  or  that  Small- 
pox owes  its  production  to  malaria  (bad  air). 
Some  critics  will  say,  "who  ever  claimed  that 
malaria  did  cause  Typhoid  Fever  or  Smallpox?  " 


WHAT   IS    MALARIA?  21 

All  of  you  who  claim  that  malaria  causes 
Chills  and  Fever  (and  nearly  every  physician 
is  wont  to  ascribe  this  disease  to  the  cause 
under  consideration)  must,  if  you  be  honest, 
admit  that  malaria  has  just  as  much  influence  in 
producing  Typhoid  Fever  and  Smallpox,  as  it  has 
in  causing  Chills  and  Fevers,  because  bad  or  im- 
pure air  is  the  causative  agent  in  each  case.  But 
in  each  case  the  malaria  or  bad  air  must  contain 
some  particular  impure  or  bad  element  which  is 
capable  of  producing  the  particular  disease  under 
'consideration.  Therefore,  the  idea  which  at 
present  prevails  of  malaria  is  very  erroneous  and 
misleading.  For  instance,  if  we  speak  of  Typhoid 
Malaria,  of  Smallpox  MALARIA,  of  Diphtheritic 
MALARIA,  and  so  on,  we  are  correct,  because  we 
here  convey  the  idea  of  an  impure  air  or  atmos- 
phere, the  principal  impurity  in  which  is  capa- 
ble of  producing  Typhoid  Fever,  Smallpox  or 
Diphtheria,  and  so  we  denominate  the  special 
poisonous  ingredient  as  well  as  the  whole  of  which 
it  forms  a  part,  and  in  which  it  constitutes  the 
most  active  ingredient.  To  illustrate  :  the  family 
of  SMITH  is  an  exceedingly  extensive  one. 
Scarcely  any,  in  fact,  I  imagine  none,  of  my  read- 
ers are  denied  the  acquaintanceship  of  very  many 
of  the  name.  The  word  Smith  is  no  less  nor  more 
familiar  than  the  word  malaria.  If  a  friend  de- 
sires to  tell  you  something  about  a  certain  man, 


22  WHAT    IS    MALARIA? 

and  after  describing  his  characteristics,  informs  you 
that  his  name  is  Smith,  he  leaves  you  with  a  very 
vague  and  illy  defined  notion  of  whom  he  has 
been  talking  about.  You  have  a  very  indefinite 
idea  of  the  individuality  of  the  person  "referred  to, 
and  should  you  afterwards  meet  the  man  whose 
characteristics  had  been  described  to  you,  and  be 
told  that  his  name  was  Smith,  you  would  still,  in 
many  cases  fail  to  recognize  the  man  about  whom 
you  had  been  told.  But  should  your  informant, 
after  describing  the  characteristics  and  personal 
appearance  of  the  man,  finish  by  telling  you 
that  his  name  was  Abraham  Smith,  you  would 
then  have  a  very  definite  idea  of  the  whole  nature 
of  a  certain  individual,  who  would  be  represented 
to  your  mind  by  the  words  Abraham  Smith,  and 
upon  hearing  these  words  you  would  at  once  feel 
intimate  with  and  perfectly  capable  of  describing 
the  elementary  characteristic  points  and  personal 
peculiarities,  the  grand  combination  of  all  of 
which  would  be  represented  to  your  mind  by  the 
two  words  constituting  the  name  of  the  individual 
possessing  these  characteristics.  So  it  is  with 
Malaria.  There  is  no  doubt  that  many  diseases 
are  developed  through  the  agency  of  impure  air, 
but  when  we  come  to  special  diseases,  characterized 
by  special  symptoms,'  we  must  look  for  a  special 
cause,  and  finding  it,  give  it  a  special  name. 
TThe  disease  popularly  known  as  "  Chills-and- 


WHAT    IS    MALARIA?  23 

Fever"  when  properly  developed,  possesses  for 
its  chief  peculiarity  periods  of  intermission  in 
the  manifestation  of  its  symptoms,  hence  the 
name  of  Intermittent  Fever,  a  most  appropriate 
one ;  if  we  desire  to  give  a  name  to  the  causative 
agent  of  Intermittent  Fever,  and  if  we  designate 
this  cause  as  malaria,  we  open  the  door  to  untold 
misunderstandings  and  confusions.  One  person 
is  exposed  to  the  evil  influences  of  malaria,  or 
bad  air,  and  is  seized  with  Intermittent  Fever, 
while  his  neighbor,  also  exposed  to  bad  air  or 
malaria,  suffers  from  Typhoid  Fever,  and  a  third 
from  Smallpox.  It  is  just  as  correct  to  assign  the 
production  of  Typhoid  Fever  to  malaria  as  it  is  to 
claim  it  as  the  cause  of  Intermittent  Fever,  since 
in  each  instance  bad  air  has  caused  the  disease. 
But  in  order  that  our  nomenclature  may  be  intel- 
ligible and  non-confusing,  it  becomes  necessary, 
when  using  the  comprehensive  term  malaria,  to 
qualify  it  with  a  prefix,  as  we  have  seen  was  neces- 
sary in  the  case  of  the  comprehensive  name  of 
Smith,  and  to  speak  of  Intermittent  malaria, 
Typhoid  malaria,  and  so  on.  Thus,  then,  the 
proper  definition  of  Typhoid  Malaria,  is  or  should 
be  as  follows,  "Bad  or  impure  air;  the  impure 
element,  or  if  there  be  many,  the  chief  and  most 
potent  impure  element  of  which  is  capable  of  giving 
rise  to  Typhoid  Fever. ' '  We  have  been  discussing 
what  malaria  is  not,  let  us  now  see  what  it  is.  In 


24  WHAT    IS    MALARIA? 

order  that  the  functions  of  the  human  body  may 
be  properly  carried  on,  it  is  absolutely  necessary 
that  pure  air  should  be  supplied  to  the  body. 
Typically  pure  air  is  composed  as  follows :  seven- 
ty-nine per  cent,  nitrogen  gas,  twenty-one  per 
cent,  oxygen  gas,  some  watery  vapor,  and  ammonia. 
This  is  the  composition  of  ideal  atmospheric  air. 
Such  air  is  the  best  adapted  for  the  maintenance 
of  healthy  life  ;  but  such  air,  with  exactly  such  a 
composition,  is  rarely  found.  In  some  localities 
and  on  some  occasions  particles  of  dust,  of  ashes, 
of  coal  and  the  like,  will  be  found  in  the  atmos- 
phere. The  air  of  a  city  like  Pittsburgh  will  con- 
tain many  other  impurities  resulting  from  the 
burning  of  coal.  The  air  in  certain  buildings 
used  for  manufacturing  purposes  will  contain 
certain  foreign  elements  derived  from  the  manu- 
facture carried  on  therein.  Thus,  in  steel  factories 
the  air  will  be  found  to  contain  small,  almost 
microscopic  particles  of  steel.  In  chemical  labor- 
atories the  atmosphere  will  contain  certain  foreign 
gases  or  vapors  liberated  during  the  manufacture 
of  certain  drugs.  In  bone-boiling  establishments 
the  air  will  be  rendered  very  impure  by  the  de- 
composition of  the  fragments  of  animal  tissue 
adhering  to  the  bones,  as  well  as  the  animal  por- 
tions of  the  bones  themselves.  <•  In  a  large  city  it 
is  almost  an  impossibility  to  discover  an  atmos- 
phere which  approaches  at  all  near  to  the  ideal 


WHAT    IS    MALARIA?  25 

one  given  above.     So  numerous  and  so  various 
are  the  sources  of  impurity,  that  even  the  healthi- 
est  portion   of  the  city  must  have  its  air  vitiated 
more  or  less.     Where,  then,  can  typically  pure  air 
be  found  for  our  use  ?      Nowhere.      A  most  as- 
tonishing, but  a  true  statement.     Such  air  as  we 
have  described   as  typically  pure  does  exist,  but 
we   cannot   now  and   never   can  find  it  for  our 
use.     It  exists  in  virgin  plains,  forests,  and  moun- 
tains  uninhabited   by   animal   life.     It   may  be 
found  in  mid-ocean.     But  let  man  approach   to 
hunt  for  this  beautiful  atmosphere,  and  like  the 
frightened  fawn  it  eludes  his  grasp  and  rushes  with 
the  velocity  of  the  deer  from  his  presence.     This 
is  literally  true.     Man   contaminates   that  which 
he  uses.     Let  conceited  and  foolishly  egotistical 
people  remember  this  in  the  midst   of  their  self 
adulation.     That   they  are   absolutely  so   rotten 
that  they  instantly  render  foul  the  purest  air  if  it 
merely  enters  their  worthless  bodies.     This  is  true, 
and  I  will  prove  it  to  you.     Suppose  you   are  in 
the  presence  of  such  an  ideal  atmosphere  as  I  have 
described  to  you  ;  you  inspire  and  receive  into 
your   lungs  a.  certain  amount   of  this  air ;   in  the 
next  instant  you  expire  and  give  forth  a  bulk  equal 
to  that  which  you  received.     But  how   changed. 
Instead   of  the   pure   and   vivifying  oxygen  gas 
which  formed  the  vital  principle  of  the  air  which 
you   inspired  but  a  few   seconds   before,  the  air 
c 


26  WHAT    IS    MALARIA? 

given  out  is  laden  with  carbon,  a  most  impure 
and  ^poisonous  element,  and  this  impurity  has 
been  derived  from  your  rotting  body.  You  can 
now  understand  what  I  mean  when  I  make  the 
statement  that  perfectly  pure  air  can  be  nowhere 
found  for  our  use,  since  the  very  instant  we  com- 
mence to  use  it,  we  render  it  foul  by  the  admix- 
ture with  it  of  the  impurities  from  our  bodies. 
By  a  wise  provision  of  nature,  however,  this 
carbon  impurity,  as  well  as  all  other  impuri- 
ties, is  soon  removed  from  the  air,  which  is  ren- 
dered once  more  fit  for  use.  While,  as  I  say,  we  can 
nowhere  find  typically  pure  air  for  our  use,  yet  air 
sufficiently  pure  to  maintain  healthy  life  can  be 
found  everywhere ;  and  it  is  a  deviation  from,  a 
deterioration  of,  this  ordinarily  pure  air  which  I 
propose  to  call  Malaria.  Now,  then,  in  con- 
clusion, I  will  define  Malaria  for  you,  and  will 
furnish  the  definition  in  two  words,  BAD  AIR. 
Finally,  let  me  say  that  throughout  this  little 
book,  when  talking  about  Malaria,  I  am  not  talk- 
ing about  Intermittent  Fever.  I  have  already 
given  my  reasons  for  saying  that  it  is  an  erro- 
neous and  misleading  view  to  hold  that  Malaria 
is  the  cause  of  Chills  and  Fever.  There  is  no 
specific  relation  between  them.  This  book  has 
nothing  to  do  with  Chills  and  Fever.  I  believe, 
as  all  of  my  professional  brethren  do,  that  the 
active  causative  agent  of  intermittent  fever  is  still 


WHAT    IS    MALARIA?  27 

a  mystery,  but,  differing  with  some,  and  with  the 
sanction  of  others,  I  say  that  it  is  erroneous  to 
apply  the  comprehensive  term  malaria  to  this 
special,  mysterious,  unrecognized  agent.  Again, 
I  have  nothing  to  do  here  with  Intermittent  Fever 
nor  its  cause ;  I  do  not  discuss  either.  I  am  enun- 
ciating and  explaining  what  I  believe  to  be  the 
proper  condition  expressed  by  the  word  malaria, 
and  helping  you  to  avoid  the  many  evils  which 
will  result  from  this  condition. 


28  WHERE    IS    MALARIA    FOUND? 


CHAPTER  II. 

WHERE    IS    MALARIA    FOUND? 

Malaria  CAN  be  found  everywhere  and  SHOULD 
be  found  nowhere.  Malaria  is  entirely  and  com- 
pletely under  human  control.  Give  me  the 
healthiest  locality  in  the  world,  and  I  will  develop 
there  malaria  in  twenty-four  hours.  Give  me  the 
most  malarious  district  of  the  globe,  and  in  time  I 
will  remove  from  it  every  trace  of  malaria.  In 
this  bold  statement  I  include  malaria  according 
to  my  definition  of  it.  Let  us  imagine  a  house  in 
the  country,  situated  on  an  eminence,  from  which 
the  ground  slopes  in  every  direction.  Suppose 
the  water  supply  to  be  perfect  and  plenty,  while 
the  drainage  is  beyond  reproach.  Imagine  the 
surrounding  atmosphere  to  be  of  that  typical 
degree  of  purity  described  in  the  last  chapter ; 
allow  that  all  the  rooms  are  sufficiently  large  and 
the  ceilings  high  enough  to  admit  of  perfect  ven- 
tilation and  to  insure  to  each  occupant  of  the 
house  a  liberal  supply  of  air.  Would  you  not 
think  such  a  house  impregnable  to  disease ;  would 
you  not  imagine  such  a  locality  the  greatest  foe  to 
malaria;  would  you  not  consider  bad  air  an  im- 
possibility !  If  you  did,  you  would  be  right. 


WHERE    IS    MALARIA    FOUND?  29 

Such  a  location  ought  to  be  entirely  free  from 
malaria;  but  see  how  soon  and  how  easy  bad  air 
can  be  produced  in  this  temple  of  health.  Sup- 
pose this  house  faces  north  and  south ;  suppose  the 
kitchen  is  at  the  southern  end ;  outside  of  the 
kitchen  door  you  have  constructed  a  wooden 
trough  with  a  lid,  in  which  you  place  your  slop 
pail.  After  dinner  the  cook  empties  the  remnants 
from  your  table  into  this  pail,  and  with  the  pro- 
verbial carelessness  of  servants,  neglects  to  shut 
down  the  lid.  The  hot  July  sun  beats  down  on 
this  mass  of  organic  matter,  decomposition  takes 
place,  and  foul  gases  are  liberated ;  if  the  wind  is 
blowing  from  the  south,  these  poisonous  gases  are 
carried  in  the  back  kitchen  door,  are  blown 
through  the  house,  they  mingle  with  the  atmos- 
phere there,  and  the  air  of  your  supposed  healthy 
house  becomes  malarious,  it  is  bad.  Again,  your 
privy  may  be  situated  some  distance,  sufficiently 
far,  from  your  house.  It  may  be  on  sloping  ground 
and  may  be  well  drained.  The  solid  evacuations 
deposited  therein  remain  there  and  decompose, 
liberating  poisonous  gases  which  ascend  and  min- 
gle with  the  atmosphere.  If  you  know  anything 
about  hygiene,  you  instruct  your  hired  man  to 
throw  dry  earth  into  your  privy  well  two  or  three 
times  a  week,  according  to  the  frequency  with 
which  it  is  used,  which  will  have  the  effect  of 
disinfecting  the  privy  and  destroying  these  pois- 


30  WHERE    IS    MALARIA    FOUND? 

onous  gases.  In  the  majority  of  cases  he  neglects 
to  do  this,  and  these  impurities  are  allowed  to 
mingle  with  and  contaminate  the  atmosphere 
and  to  produce  malaria.  You  have  water  closets 
in  your  house,  the  drainage  from  which  is  perfect, 
the  water  supply  to  them  is  also  good ;  you  never 
suspect  that  they  can  possibly  be  a  cause  of  evil, 
and  therefore  never  use  any  disinfectants.  Some 
particles  of  solid  matter  may  cling  to  a  joint  or 
bend  in  the  pipe,  and  decomposing,  produce  ma- 
laria in  the  room  in  which  your  water  closet  is, 
from  which  it  is  wafted  all  over  the  house.  Your 
drain  pipe  terminates  in  a  well,  a  long  distance 
from  your  house;  you  are  busy,  and  neglect  to 
examine  this  well ;  it  gradually  fills,  until 
finally  its  contents  reach  up  to  the  opening 
of  the  drain  pipe.  Foul  gases  ascend  this  pipe 
and  pass  along  unobstructed  until  they  reach 
the  trap  under  the  water  closet ;  here  they  are 
halted  for  a  time  by  the  water  in  the  trap,  but, 
by  degrees,  and  particularly  if  the  closet  is  not 
often  used,  the  water  becomes  saturated  with  them 
and  soon  commences  to  liberate  them  from  its 
upper  part,  and  the  air  of -the  room  and  the  house 
becomes  malarious.  How  common  is  it  for  cooks 
to  throw  the  water  in  which  they  have  been  wash- 
ing dishes  out  on  the  ground.  This  water  contains 
particles  of  organic  matter ;  the  water  soaks  into 
the  ground  and  leaves  the  organic  matter  on  the 


WHERE    IS    MALARIA    FOUND?  31 

surface,  where  it  decomposes  and  poisons  the  at- 
mosphere. Many  persons  use  the  bed  chamber 
before  retiring  at  night,  and  allow  it  to  stand  in 
their  bed  rooms  uncovered  all  night.  Its  contents 
decompose  and  render  malarious  the  air  of  your 
sleeping  room.  Manure  heaps  are  frequently  al- 
lowed to  accumulate  very  near  the  house  ;  they 
consist  of  organic  matter,  which,  decomposing, 
makes  the  atmosphere  bad.  It  is  a  very  common 
and  very  erroneous  notion  that  all  residents  of  the 
country  must,  because  they  live  in  the  country,  be 
very  healthy.  I  am  practicing  among  country  peo- 
ple, and  I  know  whereof  I  speak.  From  the  many 
illustrations  I  have  given,  you  can  readily  under- 
stand how  easily  atmosphere  naturally  pure  may 
become  contaminated  and  unfit  to  support  healthy 
life.  Such,  unfortunately,  is  the  case  among  the  ma- 
jority of  country  people.  They  know  nothing  about 
hygiene,  and  consequently  fall  into  the  very  errors 
I  have  pointed  out  to  you,  all  of  which  really  de- 
pend on  the  imperfect  and  incomplete  removal 
from  their  vicinity  of  decomposing  organic  mat- 
ter. In  cities  these  matters  are  regulated  and  at- 
tended to  by  competent  persons,  hence,  strange 
as  it  may  appear,  the  residents  of  the  better  por- 
tions of  our  large  cities  suffer  less  from  the  effects 
of  malaria  or  bad  air  than  country  people  do. 
While  in  the  country  we  find  a  lesser  propor- 
tion of  serious  and  special  diseases  than  in  the 


32  WHERE    IS    MALARIA    FOUND? 

city,  yet  we  find  a  much  larger  proportion  of 
persons  suffering  from  depraved  health,  and  de- 
pressed functional  activity,  as  a  result  of  the  use 
of  impure  air.  Now,  malaria,  or  bad  air,  is  always 
produced  by  the  decomposition  of  organic  mate- 
rial, hence,  to  put  the  matter  in  a  nut-shell,  mala- 
ria will  always  be  found  wherever  we  find  dead 
organic  matter,  and  since  dead  and  decomposing 
organic  matter  must,  as  a  necessity  of  life,  be  found 
everywhere,  so,  therefore,  malaria  must  be  found 
everywhere.  True,  as  an  abstract  principle,  but 
a  statement  admitting  of  qualification  and  expla- 
nation. The  gases  resulting  from  organic  decom- 
position, must,  of  course,  exist  everywhere ;  this  is 
true.  Their  presence  must  contaminate  the  air; 
true  enough.  But,  as  I  have  already  told  you,  the 
air  will  admit  of  a  certain  amount  of  impurity, 
without  becoming  unfit  to  sustain  healthy  life.  It 
is  only  when  these  impurities  become  concen- 
trated and  intensified  to  an  injurious  extent,  that 
they  have  the  power  to  make  air  malarious  or  bad. 
This  is  well  illustrated  in  the  contamination  of 
air  from  respiration.  I  have  already  told  you 
that  at  every  expiration,  you  give  out  from  your 
lungs  into  the  surrounding  air  a  certain  amount 
of  carbon,  which  is  poisonous  ;  in  the  course 
of  twenty-four  hours  the  amount  of  this  poi- 
son given  off  from  an  average  healthy  man,  if 
all  collected,  would  amount  to  about  eight  ounces 


WHERE    IS    MALARIA    FOUND?  33 

of  solid  carbon.  Given  off  gradually,  as  it 
is,  it  mixes  with  the  surrounding  air  and  be- 
becomes  so  diluted,  and  finally  so  altered  in  com- 
position, by  the  vegetable  life  about  us,  that  it 
becomes  perfectly  harmless.  On  the  other  hand, 
shut  yourself  up  in  a  room  ten  feet  square  and  ten 
feet  high,  hermetically  seal  all  openings,  and 
varnish  with  some  impervious  wash  the  walls,  in 
order  that  there  may  be  neither  ingress  nor  egress 
of  air.  This  room  will  contain  one  thousand  cubic 
feet  of  air .  At  the  end  of  one  hour  all  of  the  oxygen 
in  this  room  will  have  been  used,  and  in  its  place 
will  be  found  carbon.  At  the  end  of  a  second 
hour  you  will  in  all  probability  be  dead,  from  char- 
coal or  carbon  poisoning.  Had  this  same  little 
room  been  ventilated,  you  might  have  lived  in  it 
with  impunity,  without  ever  leaving  it,  for  fifty 
years.  Hence  you  see  the  danger  of  impurity  in 
the  air  is  not  so  much  from  the  mere  presence  of 
the  impurity  as  it  is  from  the  concentration  and 
accumulation  of  it,  which  can  only  result  in  the 
impure  gases  displacing  and  substituting  the  pure 
elements  of  natural  air.  I  could  hold  my  head 
over  a  privy  well  and  suffer  no  ill  effects  from  the 
poisonous  gases  arising  therefrom,  if  a  fan  were 
revolving  near  me,  constantly  forcing  a  copious 
stream  of  pure  air  across  my  face,  thus  diluting 
the  privy  impurities  to  such  an  extent  as  to  render 
them  harmless.  This  point  is  remarkably  well 


34  WHERE    IS    MALARIA    FOUND? 

illustrated  in  the  city  of  Chicago.  The  Chicago 
river  runs  through  the  centre  of  the  city.  Of  all 
foul  streams  that  ever  were  found  this  is  surely  the 
foulest.  So  intensely  foul  are  the  odors  arising 
from  it,  that  any  one  who  has  not  lost  all  sense  of 
smell  must  necessarily  hold  his  nose  when  crossing 
it.  And  yet,  strange  as  it  may  seem,  vital  statistics 
prove  Chicago  to  be  one  of  the  healthiest  cities  in 
the  United  States.  Every  once  in  a  while  a 
strong  wind  coming  in  from  the  lake  will  blow 
these  foul  gases  away  from  the  city  and  carry  them 
off  to  the  boundless  prairies  of  the  west,  where 
they  become  diluted  down  to  a  healthy  degree. 
Were  it  not  for  these  life-saving  winds,  Chicago 
would  soon  be  depopulated  by  a  malarious  plague. 
It  is  not  necessary  that  the  organic  matter  whose 
decomposition  gives  rise  to  malaria  should  belong 
to  the  animal  world.  The  vegetable  kingdom 
will  furnish  it  equally  well.  Thus  it  is  that  the 
atmosphere  is  rendered  malarious  or  bad  in  the 
vicinity  of  marshy  districts.  During  the  rainy  or 
wet  season  this  land  is  covered  with  water ;  the 
vegetation  thereon  becomes  water-soaked.  The 
hot  sun  beats  down  upon  it  and  we  have  the  two 
prime  factors  of  decomposition,  heat  and  moisture. 
On  high  and  well  drained  land  this  cause  for 
malaria  will  not  be  found,  since  the  water  will 
run  off  and  soak  away  as  fast  as  it  falls,  leaving 
but  little  remaining  when  the  sun  appears,  so 


WHERE    IS    MALARIA    FOUND?  35 

little  that  it  is  soon  absorbed  by  the  sun  and  carried 
away,  thus  removing  one  of  the  essential  elements 
for  the  organic  decomposition  and  the  production 
of  malaria.  It  has  often  been  said,  and  with  truth, 
that  new  settlements  are  particularly  prone  to  be 
unhealthy,  are  in  a  particular  manner  afflicted  with 
malaria.  Bearing  in  mind  what  I  have  said  about 
the  nature  of  malaria,  and  discarding  all  consider- 
tion  of  that  particular  malarial  element  which  is 
capable  of  producing  Intermittent  Fever,  of  the 
nature  of  which  I  have  confessed  our  present  igno- 
rance, this  phenomena  is  very  easy  of  explanation. 
All  land,  all  soil  that  has  never  been  before  worked 
is  particularly  rich  in  organic  matter.  The  leaves 
from  the  trees  have  for  centuries  been  dying,  de- 
composing and  yielding  their  organic  constituents 
to  this  earth.  The  birds  and  wild  animals  which 
from  the  beginning  of  time  have  roamed  over 
this  virgin  land  have  deposited  their  organic  ex- 
crement upon  it.  The  winds  have  wafted  organic 
material  from  far-off  cities  to  it ;  while  countless 
myriads  of  animals  have  died  and  decomposed  on 
this  land,  yielding  up  their  component  parts  to  it. 
The  rains  and  snows  of  centuries  have  washed  all 
this  organic  material  into  the  earth,  until  this  land 
fairly  teems  with  organic  wealth ;  like  the  untrod- 
den prairies  of  our  western  country  it  is  black  with 
organic  richness.  Some  little  of  this  material  is 
utilized  in  giving  nourishment  to  the  grass  and 


36  WHERE    IS    MALARIA    FOUND? 

trees  which  grow  on  this  soil ; 4  still,  but  a  very 
small  proportion  of  this  organic  matter  is  thus 
consumed,  and  what  little  is  used  is  returned  a 
hundredfold  in  the  manner  I  have  indicated  above, 
until  the  subsoil  of  this  region  is  fairly  reeking 
with  organic  elements  not  exposed  to  the  sun, 
while  that  very  near  the  surface  is  consumed  by 
the  grass  and  trees,  as  I  have  already  pointed  out. 
This  soil  contains  moisture.  Man  and  civilization 
come  along;  the  plough  turns  up  this  land;  this 
enormous  accumulation  of  organic  matter  is  ex- 
posed to  the  sun.  What  have  we?  Organic  ma- 
terial, heat  and  moisture.  What  results  /  Organic 
decomposition  and  malaria.  In  addition  to  this 
fact,  poisonous  gases  will  be  developed  also  from 
the  decomposition  of  the  organic  waste  which 
always  necessarily  attends  the  presence  of  man, 
and  which,  owing  to  the  imperfect  methods  of  drain- 
age or  removal  which  always  obtain  in  new  settle- 
ments, will  not  be  taken  from,  but  allowed  to  re- 
main in  close  proximity  to  the  residents,  there  to 
decompose  and  render  the  air  malarious.  In 
course  of  time,  as  the  ground  becomes  more  cutli- 
vated  and  successive  crops  are  taken  from  it,  the 
locality  loses  its  malarious  character,  the  air  be- 
comes purer,  because  the  excess  of  organic  mat- 
ter is  consumed  in  giving  nourishment  to  veget- 
able life ;  until  finally  this  depletion  becomes  so 
great  that  it  is  necessary  to  furnish  to  this  same 


WHERE    IS    MALARIA    FOUND?  37 

soil  decomposing  organic  matter  in  the  shape  of 
manure,  else  the  land  will  be  too  poor  in  these 
elements  to  furnish  nutrition  to  vegetable  life. 
Again,  I  find  it  stated  that  malaria  is  very  preva- 
lent in  the  northwestern  parts  of  the  city  of  Phila- 
delphia and  in  West  Philadelphia.  That  it  occurs 
on  high  ground,  where  a  large  amount  of  soil  is 
continually  disturbed  in  grading  streets,  draining, 
etc.  Here,  again,  we  have  the  conditions  to 
which  I  have  already  referred,  the  exposure  to 
the  heat  of  the  sun  of  large  masses  of  moist  organic 
matter  (which  has  hitherto  been  buried  away  from 
the  sun's  influence),  and  its  consquent  decomposi- 
tion, with  the  liberation  of  poisonous  gases  and 
the  production  of  bad  air.  In  cities  a  great  and 
prominent  cause  of  malarious  or  bad  air  is  found 
in  the  method  now  in  use  of  illuminating  the  streets 
and  buildings  with  our  ordinary  gas.  Illumi- 
nating gas  is  a  compound  of  the  two  gases,  carbon 
and  hydrogen.  When  the  match  is  applied  to  this 
compound  a  chemical  change  takes  place.  The 
carbon  unites  with  the  oxygen  of  the  surrounding 
atmosphere  and  carbonic  acid  results.  Not  only 
is  a  very  poisonous  gas  thus  formed,  but  the  vivi- 
fying element  of  the  air,  the  oxygen,  the  principle 
which  is  so  requisite  to  healthy  life,  is  consumed 
in  large  quantities.  You  have  very  little  idea  how 
great  this  source  of  contamination  is  in  large  cities. 
To  impress  it  on  your  memories,  I  will  quote  from 


38  WHERE    IS    MALARIA    FOUND? 

an  article  in  the  Revue  Scientifique,  by  M.  G. 
Robinet,  who  says:  "  The  combustion  of  illumi- 
nating gas,  in  Paris  (218,813,875  cubic  metres) 
alone,  produced  last  year  a  quantity  of  carbonic  acid 
thirty-five  hundred  times  more  considerable  than 
all  the  dead  buried  in  the  cemeteries  during  five 
years  could  give  at  the  maximum  rate  of  exhala- 
tion. The  grand  Opera  House  alone  gives  out 
every  year  thirteen  times  more  carbonic  acid  from 
its  gas  lights  than  could  be  disengaged  from  all 
the  cemeteries  put  together,  even  if  all  their  carbon 
were  converted  into  gas. ' '  Will  you  wonder  any 
more  at  the  sense  of  languor  and  oppression,  some- 
times amounting  to  a  positive  headache,  which 
you  so  often  experience  after  a  long  evening  passed 
in  a  crowded  theatre  ?  Will  you  wonder  at  the 
pale,  anaemic,  cachectic  appearance  of  so  many  of 
the  residents  of  a  large  city?  The  electric  light 
now  coming  into  such  general  use  seems  to  prom- 
ise a  relief  from  this  source  of  impure  air,  and  this 
alone  should  be  a  great  argument  in  its  favor. 
Another  source  of  impure  air  in  cities  may  arise 
from  the  ice  supply.  If  this  ice  be  cut  from  im- 
pure water,  it  will  necessarily  contain  some  of  the 
impurities  of  the  water  from  which  it  has  been  cut, 
and  melting,  will  liberate  these  particles,  allowing 
them  to  be  wafted  through  the  house.  To  illus- 
trate this  means  of  contamination,  I  will  quote 
from  the  Louisville  Medical  News,  in  which,  in 


WHERE    IS    MALARIA    FOUND?  39 

the  course  of  an  article  on  "  The  Sources  of  Ice 
Supply,"  the  editor  says,  " Again,  any  one  who 
has  traveled  from  Joliet  to  Chicago,  on  the  St.  L. 
A.  and  C.  R.  R.,  cannot  have  failed  to  notice  the 
long  line  of  ice  storehouses  which  stretch  for  miles 
along  the  banks  of  the  Des  Plaines  river.  This 
beautiful  stream  is  one  of  the  sources  of  the  Illi- 
nois. It  runs  through  miles  of  rich  prairie  land, 
and  formerly  drained  nothing  worse  than  the  many 
farmers'  barnyards,  and  a  dozen  thrifty  villages 
along  its  banks ;  but  now,  alas  !  it  is  disgraced 
for  a  considerable  part  of  its  course  by  the  com- 
panionship of  the  Illinois  and  Michigan  canal,  the 
outlet  for  the  sewage  of  Chicago — a  sluice  of  filth 
which  might  well  put  in  a  claim  for  rivalry  with 
the  Thames,  after  London  is  passed.  Not  a  fish 
dares  venture  into  its  water ;  not  a  stranger  ap- 
proaches its  bank  without  holding  his  nose ;  and 
upon  either  side  of  it  is  a  strip  of  country  where 
filth  diseases  abound ;  diphtheria,  for  instance, 
being  a  perpetual  heritage  to  the  unfortunate  in- 
habitants. A  curious  situation  for  the  sanitarian 
to  contemplate.  On  one  side  is  the  loveliest  of 
the  '  laughing  rivers  that  run  in  haste  to  form  the 
Illinois  ;  '  upon  the  other,  and  at  a  higher  level, 
the  open  sewer  of  a  mighty  city  rolls  its  stinking 
sheet  of  suspended  filth  sluggishly  on  to  the  same 
destination,  and  between  the  two  a  narrow  strip  of 
land  covered  with  houses  wherein  is  stored  the  ice 


40  WHERE    IS   MALARIA    FOUND  ? 

for  Chicago.  It  may  be  urged  that  there  is  no 
surface  communication  between  the  waters  of  the 
river  and  the  canal ;  but  who  can  doubt  that  there 
are  many  subterranean  courses  of  contact ;  and  at 
times  of  freshet,  when  the  Des  Plaines  overflows 
its  banks  and  the  canal  is  high  up  in  its  walls, 
there  is  doubtless  a  commingling  of  the  waters  at 
some  points  above  ground.  Besides,  if  direct  com- 
munication could  be  proved  to  be  impossible,  who 
will  say  that  nightly  the  clean  water  of  the  river 
does  not  absorb  myriads  of  disease-producing 
germs  from  the  vapors  and  exhalations  that  arise 
from  this  uncovered  sewer  ?  All  the  laws  regula- 
ting the  diffusion  of  microscopic  organisms  testify 
to  the  truth  of  the  proposition ;  and  if  there  is  any 
warrant  for  the  statement  that  diseases  of  a  zymotic 
character  can  be  propagated  through  drinking 
water,  the  dweller  on  the  banks  of  the  Des  Plaines, 
from  the  point  where  the  canal  first  approaches  the 
river  to  its  mouth,  had,  during  a  fatal  epidemic  in 
Chicago,  better  say  his  prayers  before  placing  a 
cup  of  its  innocent-looking  water  to  his  lips.  We 
believe  that  the  ice  supply  of  Chicago  is  chiefly 
derived  from  this  source  ;  and  if  so,  does  it  not  ac- 
count, to  some  extent,  for  the  present  unusually  bad 
health  of  that  metropolis?"  Fortunately  for  the 
residents  of  Philadelphia  this  danger  does  not 
.exist  in  ice  cut  from  the  Schuylkill  river,  since 
Professor  Leffmann  tells  us  some  interesting  facts 


WHERE    IS    MALARIA    FOUND?  41 

concerning  the  purity  of  this  water,  which  will 
possess  so  much  interest  for  all  residents  of  the 
city  that  I  give  his  remarks  in  full :  "  It  is  my  pur- 
pose to  take  only  a  few  minutes  to  give  some 
results,  or  rather  conclusions,  which  have  been 
derived  from  recent  analyses  of  our  water  supply. 
Very  little  is  heard  about  the  hygienic  relations  of 
Schuylkill  water,  probably  because  public  opinion 
has  long  since  settled  to  the  conclusion  that  it  is  a 
good  water.  Nevertheless,  as  visitors  sometimes 
complain  of  it,  and  as  newspapers  in  their  flings  at 
the  Water  Department  not  infrequently  condemn 
the  quality  as  well  as  the  quantity  of  the  supply,  I 
have  ventured  to  take  up  the  Society's  time  long 
enough  to  say  that  examinations  made  at  various 
times  during  the  winter  and  spring  have  shown 
that  the  water  is  of  fair  quality  and  cannot  be  re- 
garded as  an  active  cause  of  disease  in  our  city. 
It  is  an  insipid  water,  lacking  the  pleasant  taste  and 
sparkling  character  of  spring  water,  especially  of  the 
so-called  hard  waters,  and  this  lack  is  often  taken 
as  evidence  of  impurity.  During  the  periods  of 
freshet  it  becomes  quite  turbid,  from  the  suspen- 
sion of  particles,  mostly  silicious,  but  such  suspended 
matter  rarely  exceeds  a  grain  or  two  to  the  gallon, 
and  the  individual  particles  are  too  minute  to  cause 
any  irritation.  In  the  turbid  water  several  species 
of  harmless  animalculae  can  usually  be  detected. 
In  making  any  brief  statement  of  a  composition  of 


42  WHERE    IS    MALARIA    FOUND? 

a  water  we  are  embarrassed  by  the  fact  that  the 
modern  methods  of  water  analysis  are  very  strictly 
technical ;  they  give  us,  not  the  impurities  them- 
selves, but  the  amount  of  certain  indications  of 
impurity.  Without  stopping  to  explain  the  mere 
chemical  phase  of  the  question,  I  will  simply  give 
a  comparison  of  a  recent  analysis  of  Schuyl- 
kill  water  with  that  of  two  samples  of  London 
water  analyzed  by  the  same  method  and  considered 
excellent  waters: — 

Schuvlkill      Kent  Company,    Chelsea, 
bcnuylkill.          London.  London. 

Chlorine 0.53  1.2  0.51 

Ammonia,  from   organic  1 

matter J    0.0028  0.0022  0.0035 

Total  solids 7.00  34.00  17.64 

All  the  figures  are  grains  to  the  imperial  gallon. 
The  Society  of  Public  Analysts,  of  England,  has  re- 
cently proposed  a  system  by  which  each  factor  in  the 
composition  shall  be  valued  by  an  arbitrary  num- 
ber, and  all  the  numbers  being  added  will  give  us 
a  figure  representing  the  standard  of  the  water. 
In  good  waters  this  sum  will  not  exceed  35. 
Schuylkill  water  varies  from  17  to  23,  so  that  it 
comes  decidedly  below  the  limit.  In  regard  to 
Delaware  water  I  may  remark  that,  so  far  as  I  have 
examined  it,  it  is  not  as  good  as  the  Schuylkill 
water.  The  amount  of  organic  matter  is  higher 
and  the  microscopic  examination  shows  forms  of 
life  which  are  frequent  in  decomposing  materials. " 


WHERE    IS    MALARIA   FOUND?  43 

This  question  of  water  is  a  very  important  one  in 
connection  with  the  production  of  malaria,  as 
evidenced  by  the  testimony  of  many  writers,  the 
most  recent  observation  I  have  found  on  the  subject 
being  as  follows :  "  In  reference  to  the  increasing 
distribution  of  malaria,  it  is  worth  noting  that 
water  is  often  the  vehicle  by  which  the  malarial 
poison  reaches  the  system,  and  that  it  is  often 
charged  with  malaria  at  points  distant  from  the 
places  where  it  comes  to  the  surface  and  is  used. 
Thus,  it  happens  that  soils  are  often  reputed  ma- 
larious, when,  in  reality,  the  unhealthiness  is  due 
to  the  fact  just  stated."  Another  prolific  cause 
of  malaria  or  bad  air  is  the  occupancy  of  a  sleeping 
or  sitting  room  by  too  many  persons.  Experience 
teaches  that  while  life  can  be  supported  with  a 
lesser  quantity,  yet  in  order  that  the  various  func- 
tions of  the  human  body  may  be  carried  on  prop- 
erly and  without  let  or  hindrance,  each  adult 
should  be  supplied  with  three  thousand  cubic  feet 
of  air  every  hour.  This  amount  of  air  will  be 
contained  in  a  room  ten  feet  wide,  thirty  feet  long 
and  ten  feet  high.  Natural  ventilation,  that 
is  to '  say,  the  interchange  of  air  through  the 
cracks  of  doors  and  windows  and  through  the 
walls  of  a  room  or  house,  will  change  this  volume 
of  air,  will  renew  it,  three  times  in  the  course 
of  an  hour.  If  special  means  for  ventilation  exist, 
if  sufficient  ingress  for  pure  and  egress  for  impure 


44  WHERE   IS   MALARIA   FOUND? 

air  be  provided,  this  volume  of  air  will  be  renewed . 
six  times  in  every  hour.  So  that  under  the  first 
condition  not  more  than  three,  and  under  the  second 
condition  no  more  than  six  persons  should  occupy 
a  room  of  the  dimensions  given  above.  How  sel- 
dom this  rule  is  observed,  you  all  know.  These 
calculations  do  not  take  into  consideration,  you 
will  notice,  the  consumption  of  oxygen  by  the 
carbon  of  illuminating  gas,  to  which  I  have 
referred.  And  when  you  realize  that  one  burner 
will  consume  more  oxygen  in  a  given  time  than 
one  man,  you  will  appreciate  how  important  a  fac- 
tor this  may  become  in  deteriorating  and  rendering 
malarious  or  bad  the  air  of  a  room.  The  brightly 
lighted  sitting  room,  with  its  cheerful  log  fire,  all 
the  windows  and  doors  tightly  closed  against  Jack 
Frost,  and  the  crevices  hermetically  sealed  and 
stuffed,  so  that  not  a  particle  of  the  pure  and 
bracing  air  of  the  cold  and  wintry  night  may  enter, 
with  the  family  of  ten  or  twelve  passing  the  long 
evenings  of  winter  in  a  room  but  little  if  any 
larger  than  the  one  I  have  described,  may  be  very 
cosy  and  comfortable,  but  it  is  terribly  unhealthy. 
Again,  many  persons  have  a  habit  of  making  their 
own  soap,  for  washing  purposes,  using  the  waste 
fat  in  this  way.  This  is  a  most  reprehensible  and 
unhealthy  custom ;  the  fat  has  been  kept  for  some 
time,  until  it  is  in  a  state  of  decomposition,  and  then 
put  into  the  pot  to  boil,  it  sends  foul  gases  all 


WHERE    IS    MALARIA    FOUND?  45 

through  the  house.  Better  dispose  of  your  fat  in 
some  other  way,  it  will  be  more  economical  and 
much  more  sensible ;  will  be  more  healthy  and 
will  greatly  reduce  your  doctor 's  bills.  Slops  left 
standing  in  an  uncovered  bucket  in  the  back  street 
for  hours,  until  removed  in  the  swill  cart,  will  gene- 
rate bad  air.  The  sun  beats  down  on  this  moist 
mass  and  the  gases  of  decomposition  are  liberated. 
Foul  and  exceedingly  poisonous  gases  often  gain 
admittance  to  a  house  where  the  plumbing  is  not 
perfect,  through  the  outlets  for  waste  water  and 
the  overflow.  If  you  have  reason  to  suspect  this, 
indeed,  whether  you  have  or  not,  it  will  be  a  wise 
precaution  to  have  a  metallic  slide  arranged  to  the 
overflow  outlet,  and  keep  it  always  in  position  un- 
less using  this  opening,  and  to  always  have  the 
stopper  of  all  your  basins  and  bath  tubs  in  position, 
with  an  inch  or  two  of  water  in  the  basin.  While 
it  is  true  that  much  disease  is  caused  from  foul  air 
entering  the  house  from 'the  drain  pipes,  yet  such 
ought  not  to  be  the  case,  there  is  no  necessity  for 
it.  The  hue  and  cry  against  wash  stands  and 
water  closets  is  an  unjust  one.  If  properly  arranged 
and  drained  they  are  perfectly  harmless.  This 
prejudice  against  them  has  arisen,  not  from  the  fact 
that  the  system  is  wrong  or  injurious  in  itself,  but 
because  it  is  not  properly  carried  out.  How 
can  you  expect  an  ordinary  plumber,  who,  as  an 
apprentice,  has  mechanically  learned  his  trade 


46  WHERE    IS    MALARIA    FOUND? 

from  his  master,  to  know  anything  about  scientific 
plumbing  ?  He  may  do  his  work  in  a  masterly 
and  perfect  manner,  so  far  as  the  mechanical  part 
of  it  is  concerned.  But  what  does  he  know  about 
the  principles  of  hygiene.  I  make  the  assertion  that, 
if  properly  arranged,  water-closets  and  sinks  are 
by  far  the  healthiest  means  of  getting  rid  of  refuse 
matter,  and  will  support  this  assertion  by  the  state- 
ment, that  I  would  be  perfectly  willing  to  live  in  a 
house  with  a  water-closet,  sink  and  bath  tub  in 
every  room,  provided  I  had  personally  superin- 
tended the  plumbing  of  the  house.  I  will  have 
more  to  say  on  this  subject  in  the  last  chapter. 
The  slop  jar  in  a  bed  chamber  is  a  common  cause 
of  impure  air.  You  wash  your  bodies  and  empty 
the  water  into  this  jar.  The  water  contains  scales 
of  your  skin,  as  well  as  many  of  the  dead  particles 
of  your  body  given  out  through  the  pores  of  your 
skin.  This  matter  is  organic,  and  undergoes  de- 
composition. Unless  the  slop  jar  is  thoroughly 
washed  out  every  day  it  soon  becomes  foul,  and  is 
then  an  unhealthy  article  of  furniture.  Keep  it 
covered  all  the  time.  Another  prolific  source  of 
bad  air  in  winter  time  arises  from  the  modern 
method  of  heating  houses  by  furnaces  in  the  cellars. 
In  the  majority  of  instances  the  air  chamber  of  the 
furnace  derives  its  supply  of  air  from  the  cellar, 
which  must  of  necessity  be  very  impure,  since  it  is 
impregnated  with  the  ashes  and  coal  dust  and  the 


WHERE   IS   MALARIA   FOUND?  47 

various  impurities  usually  found  in  a  cellar.  If 
the  air  chamber  is  supplied  with  pure  air  from 
outside  of  the  house,  if  a  receptacle  with  water  is 
placed  near  the  register,  and  if  a  proper  outlet  in 
each  room,  for  the  air  when  it  becomes  foul,  exists, 
I  can  see  no  valid  objection  to  furnaces.  They 
certainly  heat  a  house  more  thoroughly  than  any 
other  system  in  vogue  in  ordinary  dwelling  houses, 
and  if  their  drawbacks  be  reduced  to  the  minimum 
their  use  is  to  be  commended.  Soiled  clothing 
allowed  to  accumulate  in  a  room  will  vitiate  the 
air  of  the  apartment.  The  soiling  is  due  to 
dead  organic  matter  derived  from  the  body,  and 
it  will  decompose  and  give  rise  to  malarious  or 
bad  air.  In  this  connection  a  most  reprehensible 
practice  in  common  use  must  be  emphatically 
condemned.  I  refer  to  the  habit  of  hanging  wet 
diapers  over  a  chair,  before  the  register,  to  dry. 
Children  are  particularly  susceptible  to  the  noxious 
influences  of  bad  air,  and  this  practice  will  so  vitiate 
the  air  of  their  rooms  as  to  work  serious  injury  to 
their  little  bodies.  Wash  each  diaper  as  it  is 
soiled  and  hang  it  out  of  doors,  in  the  sun,  to  dry. 
There  is  a  very  important  factor  in  the  production 
of  bad  air  which  is  so  common  and  ought  to  be 
so  thoroughly  appreciated,  that  it  seems  almost 
foolish  to  refer  to  it  here,  still,  as  it  does  exist  and 
as  very  little  effort  seems  to  be  made  to  remedy 
it,  it  may  do  soiree  good  to  dwell  on  it  for  a 


48  WHERE    IS   MALARIA    FOUND? 

little  while ;  I  mean  dirty  streets.  Street  dirt  is 
principally  derived  from  two  sources ;  slops  and 
refuse  from  houses,  and  excrement,  both  solid  and 
liquid,  from  horses,  dogs  and  the  like.  All  this 
matter  is  organic  and  undergoes  organic  decom- 
position, with  the  consequent  production  of  mala- 
rious or  bad  air.  This  is  really  the  principal 
source  of  air  contamination  in  large  cities,  as,  wit- 
ness the  city  of  New  York  last  spring  and  the  city 
of  Philadelphia  at  present.  Does  it  not  seem 
strange  that  intelligent  men  will  go  to  all  the 
trouble  and  expense  that  they  do,  to  remove  from 
their  neighborhood  all  human  excrement,  and  yet 
seem  so  indifferent  to  the  presence  of  such  enor- 
mous quantities  of  animal  excrement  in  the  streets, 
which  is,  in  reality,  nearly,  if  not  quite  as  poison- 
ous as  the  former.  Consistency,  thou  art,  indeed, 
a  jewel,  a  jewel  possessed  by  but  very  few  inhabit- 
ants of  our  large  cities.  In  my  last  chapter  I  will 
propose  a  remedy  for  this  state  of  affairs,  which 
may,  indeed,  seem  Utopian  in  conception  and  im- 
possible of  achievement,  as  it  really  is  under  our 
present  selfish  and  corrupt  system  of  government, 
but  a  plan  that  would  be  perfectly  practicable  were 
our  city  governed  by  intelligent  men,  who  had  the 
welfare  of  its  inhabitants  to  guide  them  in  their 
administration.  Whatever  city  does  first  adopt 
this  plan  will  find  a  wonderful  diminution  in  its 
mortality  rate,  and  will  deserve  and  receive  the 


WHERE    IS    MALARIA    FOUND?  49 

gratitude  of  the  whole  country  for  setting  them  an 
example,  by  following  which  the  health  of  the 
nation  will  be  greatly  benefited,  and  the  life  of 
man  prolonged.  Having  cursorily  discussed  the 
principal  causes  of  bad  air  in  the  city,  let  us  return 
again  to  the  country,  and  see  in  what  localities 
and  under  what  conditions  we  will  there  find 
malaria.  I  have  told  you  that  malaria  can  exist 
everywhere.  I  have  told  you  how  malaria  can  and 
will  be  produced  in  houses,  from  what  might  be 
called  hygienic  defects  of  living.  Let  us  now  see 
what  localities  in  the  country  are  particularly  prone, 
I  might  say  naturally,  to  be  malarious.  Let  me 
again  say  that  I  am  not  discussing  the  poisonous 
element  of  bad  air  which  is  capable  of  producing 
Intermittent  Fever,  and  about  the  nature  of  which 
we  know  really  nothing ;  this  poison  is  developed 
and  exists  in  certain  localities  which  I  could  men- 
tion, and  does  not  exist  in  others ;  but  the  malaria 
of  which  I  am  writing,  the  bad  air  I  am  telling 
you  about,  may  be  found  anywhere,  as  a  result  of 
man's  negligence  or  want  of  knowledge.  A 
healthy  cduntry  locality  might  be  described  as  fol- 
lows :  High  ground,  without  too  much  shade, 
and  with  a  rather  loose  and  porous  soil,  prefer- 
ably a  gravelly  or  gravelly  and  clayey  soil.  Such 
a  briefly  described  locality  will  be  naturally  free 
from  malaria,  and  if  bad  air  does  there  exist,  it 
will  surely  be  the  fault  of  the  resident  or  of  some 


50  WHERE    IS    MALARIA    FOUND? 

neighbor.  When  I  say  high  ground,  I  mean  com- 
paratively, and  not  positively  high.  Country  loca- 
tions may  be  very  high  when  compared  with  the 
neighboring  city  or  river  from  which  the  compari- 
sons are  made,  and  yet  be  very  low  when  com- 
pared with  the  country  immediately  surrounding 
them.  Such  a  spot  will  not  be,  naturally,  free  from 
malaria  or  bad  air.  A  pen  picture  of  a  country 
location  which  would  be  naturally  malarious,  would 
read  as  follows  :  Ground  low  when  compared 
with  the  surrounding  country,  basin-like  in  char- 
acter, with  a  hard,  clayey,  or  otherwise  impervious 
soil.  Into  such  a  location  the  refuse  from  the 
surrounding  country  would  naturally  drain.  The 
rain  descending  from  above  would,  of  course, 
flow  down  from  all  directions  into  this  basin,  and  in 
its  downward  course  would  carry  along  all  the  dead 
organic  matter  for  some  distance  around,  which 
would  accumulate  in  a  rotting  mass  on  this  low 
ground.  The  hard,  impervious  soil  would  refuse 
to  allow  this  water  to  drain  away  through  it, 
thus  compelling  it  to  lie  on  the  surface  until,  in 
the  rainy  season,  it  would  almost  form  a  small 
lake.  This,  in  the  first  place,  would  be  unhealthy, 
since  it  would,  of  necessity,  render  the  location 
very  damp.  But  a  still  greater  danger  here  exists. 
This  mass  of  water,  with  its  load  of  organic  mat- 
ter, lies  on  the  surface  of  the  ground.  After  a 
while  the  sun  appears,  and  you  can  anticipate  what 


WHERE    IS   MALARIA    FOUND?  51 

I  am  going  to  tell  occurs.  Here,  again,  we  have 
the  dead  organic  matter,  the  heat  and  moisture. 
Decomposition  necessarily  ensues,  and  the  air  be- 
comes bad.  I  am  sufficient  of  a  farmer  to  tell 
you  that  such  soil  will  produce  very  indifferent 
crops.  The  dead  and  decomposed  organic  mat- 
ter, which  in  porous  soil  would  soak  into  the 
ground  and  furnish  nourishment  for  vegetable 
life,  will  here  lie  on  the  surface,  and  furnish 
poison  for  human  animal  life.  How  can  you 
expect  a  locality  that  is  too  poor  to  grow  potatoes 
to  be  rich  and  good  enough  to  grow  children. 
Just  here,  I  will  enunciate  a  rule,  which  is  almost 
universally  correct.  It  will  serve  as  an  almost  in- 
fallible guide  in  selecting  a  country  home.  When 
you  have  found  a  high  location,  look  into  the 
character  and  nature  of  the  crops  produced.  If 
you  find  them  first  class,  you  can,  in  the  great 
majority  of  cases,  make  up  your  mind  that  such 
a  location  will  make  a  healthy  residence.  Of 
course,  you  must  find  out  whether  these  crops  are 
derived  from  the  natural  soil,  since  almost  any 
ground  can  be  made  to  produce  very  good 
crops  if  thoroughly  worked  and  manured.  Apart 
from  the  nature  of  the  locality,  the  same  care- 
lessness in  properly  disposing  of  organic  matter 
will  produce  malaria  in  the  country  that  I  have 
indicated  in  speaking  of  the  city.  But  in  the 
country  there  are  some  particularly  dangerous 


52         ,  WHERE    IS    MALARIA    FOUND? 

practices  in  vogue  which  demand  a  moment's  con- 
sideration. Thus,  in  many  cases  where  a  house 
stands  on  high  ground,  surface  drainage  is  resorted 
to.  The  drain  pipe  from  the  water  closet  and 
bath  tub  will  discharge  its  contents  on  the  surface  of 
the  ground  some  twenty  or  thirty  feet  away  from  the 
house.  This  is  most  reprehensible.  The  suppo- 
sition is  that  because  of  the  sloping  ground  this 
refuse  will  all  drain  away.  While  very  nice  in 
theory,  this  is  not  the  case  in  fact.  At  first  most 
of  this  matter  will  drain  away ;  but  in  time,  and 
especially  if  the  closet  and  bath  be  much  used,  the 
ground  in  the  vicinity  of  the  open  mouth  of  the 
drain  will  become  so  saturated  with  this  water 
that  it  will  be  unable  to  absorb  any  more.  It  will 
then  be  compelled  to  run  along  the  surface.  The 
grass  and  weeds  will  entangle  and  hold  some  of 
the  organic  matter,  which  will  decompose,  and 
when  the  wind  is  blowing  towards  the  house,  this 
poisoned  air  will  be  carried  into  it.  To  avoid 
this  really  great  danger;  great  care  and  intelli- 
gence should  be  exercised  in  arranging  the  drain- 
age. If  a  swift  flowing  stream,  in  which  there  is 
always  plenty  of  water,  even  during  the  greatest 
drought,  pass  at  all  near  the  house,  your  drain 
pipe  should  empty  into  it.  But  unless  there  is 
always  plenty  of  water  and  a  sufficiently  strong 
current  to  carry  the  waste  away,  do  not  think  of 
draining  into  it.  Because  when  the  dry  spell  comes, 


WHERE    IS   MALARIA   FOUND?  53 

and  the  bottom  of  the  small  stream  or  creek  is 
exposed  to  the  sun,  there  will  be  found  the  accumu- 
lations of  your  winter's  drainage,ready  to  decompose 
and  poison  the  air.  If  you  have  no  convenient 
stream,  select  the  very  lowest  point  on  your  land 
and  dig  there  a  deep  well.  Brick  the  sides  of  it, 
from  top  to  bottom,  and  cement  it  thoroughly,  so 
as  to  render  it  strictly  water  proof.  Let  your 
drain  pipe  empty  into  this  well.  The  bottom  of 
the  well,  being  earth,  will  allow  the  liquid  portion 
of  the  waste  to  drain  off  out  of  harm's  way. 
The  solid  portion  will  accumulate,  and  the  well 
should  be  emptied  when  it  becomes  full.  An  air- 
tight covering  should  be  always  in  position  on  top 
of  the  well.  If  you  take  these  precautions,  and  if 
your  plumbing  be  good  and  your  water-closet  trap 
efficient,  you  need  fear  no  danger  whatever  from 
this  source.  It  would  be  well,  if  possible,  for  the 
family  to  absent  themselves  from  home  when  the 
well  is  being  emptied,  and  for  you  to  employ  a  man 
for  this  work  who  makes  a  regular  business  of  it, 
because  such  a  man  will  not  be  affected  by  the 
poisonous  gases,  since  usage  breeds  a  tolerance. 
While,  if  you  were  to  employ  a  man  unaccustomed 
to  such  work,  you  might  become  the  innocent  and 
unwilling  cause  of  his  sickness,  and  may  be  of  his 
death.  Finally,  to  sum  up,  you  must  understand, 
from  what  I  have  said,  that. malaria  will  always  be 
present  wherever  dead  and  decomposing  organic 


54  WHERE    IS    MALARIA   FOUND? 

matter  is,  and  that  if  such  matter  is  allowed  to 
accumulate  in  the  vicinity  of  human  habitations, 
and  if  proper  measures  to  destroy  it  are  not  in- 
stituted, malarious  or  bad  air  will  surely  be  the 
consequence,  and  the  inhabitants  of  such  a  locality 
will  surely  suffer  from  its  baneful  influences.  You 
also  understand,  to  some  extent,  how  really  diffi- 
cult it  is,  in  many  cases,  to  avoid  the  production 
of  this  bad  air,  how  easily  it  is  generated  and 
how  insidious  may  be  its  approach.  To  make  you 
realize  still  more  how  insidious  may  be  the  march 
of  this  arch-enemy  of  health  and  longevity,  I  will 
conclude  this  chapter  with  a  quotation  from  the 
British  Medical  Journal,  in  which  Messrs.  Maguire 
&  Son,  of  Dublin,  who  have  had  great  experience 
in  the  examination  of  dwelling  houses  say :  "  In 
endeavoring  to  awaken  public  attention  to  the 
importance  of  sanitary  reform,  we  here  enumerate 
thirty  of  the  dangers  to  health  which  we  most  fre- 
quently detect  in  our  sanitary  examination  of 
houses.  Any  one  of  these  defects,  by  admitting 
foul  air,  constitutes  a  real  danger  to  health ;  but, 
in  the  large  majority  of  houses  many  of  these  de- 
fects may  be  found  existing  together,  and  in  some 
houses  they  may  nearly  all  be  found,  rendering  those 
houses  pestilential:  (i)  Common  built  drains 
under  houses;  large  built  drains  under  or  near 
mansions.  (2)  Pipe  drains  with  leaking  joints,  or 
broken,  laid  under  houses j  saturating  the  basement 


WHERE   IS   MALARIA    FOUND  ?  55 

with  sewage.  (3)  Pipe  drains  laid  under  houses, 
without  sufficient  fall,  or  with  fall  the  wrong  way. 
(4)  Drains  of  every  kind,  without  proper  inter- 
cepting traps,  admitting  foul  air  from  sewers  or 
cesspools.  (5)  Drains  of  every  description,  with- 
out a  constant  free  current  of  fresh  air  through 
them.  (6)  Rat  burrows  from  built  drains  or  sew- 
ers undermining  flags  and  floors,  and  admit- 
ting foul  air  to  house.  (7)  Rat  burrows  worked 
alongside  perfect  pipe  drains  from  street  sewers, 
and  into  houses.  (8)  Defective  connections 
between  soil  or  waste  pipes  and  sewers,  ad- 
mitting foul  air  to  houses.  (9)  Soil  pipes 
passing  through  interior  of  house,  under  almost 
any  circumstances.  (10)  Soil  pipes  inside  or  out- 
side houses,  without  any  or  sufficient  ventila- 
tion. ( 1 1 )  Defective  water-closet  apparatus.  (12) 
Water-closet  cisterns  with  overflows  joined  to  soil 
pipe  or  drain.  (13)  Safe  trays  under  closets, 
connected  to  soil  pipes  or  drain.  (14)  Two  or 
more  water  closets  or  sinks  on  same  soil  pipe,  un- 
trapping  each  other  when  used.  (15)  Sink  over- 
flow pipes  joined  to  soil  pipes  untrapped,  or  with 
trap  liable  to  un trap.  (16)  Water  supplies  to  sinks 
taken  from  water  closet  or  other  contaminated 
cisterns,  and  used  by  careless  servants  to  fill  bed 
room  caraffs  for  drinking.  (17)  House  cisterns 
and  tanks  with  overflows  direct  into  soil  pipes  or 
drains.  (18)  Traps  of  every  description  with- 


56  WHERE    IS    MALARIA   FOUND  ? 

out  ample  ventilation  to  guard  them.  (19)  Scul- 
lery sinks  connected  direct  to  drains,  admitting 
foul  air  to  houses,  not  only  through  traps,  but 
through  joints  of  brickwork  all  round,  as  shown 
by  our  smoke  test.  (20)  Bell  traps,  with  loose 
covers,  on  scullery  sinks  connected  to  drains. 
(21)  Gullies  or  traps  in  sculleries,  laundries,  lar- 
ders, etc.,  connected  to  drains,  usually  dry  and 
untrapped.  (22)  Rain  pipes  used  as  ventilators 
to  drains,  delivering  foul  air  near  bedroom  win- 
dows, or  under  eaves  or  roofs.  (23)  Ash  pits 
near  larders  and  pantries ;  ash  pits  liable  to  soak 
foul  moisture  through  house  walls.  (24)  Defects 
of  drainage  and  rat  burrows,  from  neighbors' 
houses.  (25)  Water  tanks  in  areas,  near  ash  pits 
or  sculleries,  and  with  overflows  direct  to  drains. 

(26)  Wash-stand   basins  in  dressing  rooms,  con- 
nected directly  in  any  way  to  drains  or  soil  pipes. 

(27)  Water-closet   cisterns  in  return  rooms,  fre- 
quently under   bedroom  or  parlor  floors,  perhaps 
with  overflow  direct  to  drain.     (Sixteen  years  ago 
the  writer  thoughtlessly  used  a  room  of  this  kind, 
and   was   attacked   with   Typhoid.)     (28)    Cess- 
pools  near  houses,  and    cesspools    or   defective 
drains  near  wells.     (29)  Neighbors'  drains  cross- 
ing under  houses  or  joining  drains.     (30)  Drink- 
ing water  defects,  and  all  impurities  likely  to  con- 
taminate milk,  meat,  or  food  of  any  kind."    After 
reading  this  long  list,  you  may  wonder  how  it  is 


WHERE    IS    MALARIA    FOUND  ?  57 

possible  for  any  house  to  be  healthy,  when  disease 
has  so  many  avenues  of  entrance.  Truly,  our  life 
is  one  long,  continual  warfare  against  disease.  But 
you  will  notice  that  all  these  indications,  as  well 
as  all  the  others  which  I  have  pointed  out  to  you, 
depend  upon  the  presence  of  decomposing  organic 
matter.  If  such  matter  is  not  present,  no  matter 
how  defective  the  drainage  may  be,  poisonous 
gases  cannot  enter  the  house,  because  they  cannot 
exist.  Therefore,  once  more,  in  conclusion,  ma- 
laria means  bad  air,  and  the  most  frequent  cause 
of  this  bad  air  is  organic  decomposition. 


58  SYMPTOMS    OR   SIGNS    OF    MALARIA. 

CHAPTER  III. 

SYMPTOMS    OR    SIGNS    OF    MALARIA. 

Typhoid  Fever  has  its  special  symptoms ;  so  has 
Smallpox,  Diphtheria  and  Intermittent  Fever. 
And  by  these  special  signs  or  landmarks,  as  it 
were,  is  each  particular  disease  recognized  and 
differentiated.  When  called  to  a  patient,  who 
at  regular  intervals  has  a  well  marked  chill  fol- 
lowed by  fever,  succeeded  in  turn  by  profuse 
sweating  and  a  subsequent  restoration  to  health, 
the  physician  at  once  recognizes  a  case  of  Inter- 
mittent Fever.  So  it  is  with  every  other  special 
disease.  There  are  certain  definite  signs  and 
symptoms,  the  presence  of  which  make  known  the 
nature  of  the  disease.  It  is  not  so  with  malaria. 
The  conclusion  that  a  person  is  suffering  from 
malaria  must  be  arrived  at  rather  by  a  system  of 
exclusion  of  the  symptoms  of  other  diseased  con- 
ditions, than  by  the  presence  of  any  special  char- 
acteristic symptoms  of  this  trouble.  This  is  be- 
cause malaria  or  bad  air  will  produce,  and  does 
produce,  such  a  great  variety  of  symptoms,  that  it 
frequently  simulates  many  other  diseases.  I  have 
told  you  that  pure  air  is  an  absolutely  essential 
agent  to  the  healthy  performance  of  duty  on  the 


SYMPTOMS    OR   SIGNS    OF    MALARIA.  59 

part  of  your  organs.  If,'  instead  of  pure,  bad  air 
or  malaria  enters  your  lungs  at  every  inspiration, 
and  from  your  lungs  enters  your  blood,  the  poison- 
ous elements  act  injuriously  on  your  system  at  large 
and  interfere  with  the  functions  of  healthy  life. 
Acting  thus  on  all  parts  of  the  body,  you  can 
understand  how  diverse  may  be  the  symptoms 
presented.  Every  one  of  us  has  some  particularly 
weak  spot ;  in  you  it  may  be  the  lungs,  in  another 
the  stomach,  in  a  third  the  kidneys.  Whatever 
injurious  agent  may  act  on  the  body  of  each  par- 
ticular being  will  make  itself  most  manifest  on 
this  weak  spot.  So  that  in  one  malaria  may  pre- 
sent symptoms  referable  to  the  stomach,  in  another 
to  the  lungs,  and  in  a  third  to  the  kidneys.  In 
still  another  class  of  cases  it  seems  to  exert  a  de- 
pressing and  debasing  influence  on  the  system  at 
large  ;  lacking  the  healthy  stimulus  of  pure  air,  all 
the  organs  of  the  body  seem'to  imperfectly  perform 
their  duty,  and  a  low  state  of  vitality,  a  depressed 
condition  of  the  general  health,  without  any  defi- 
nite or  peculiar  symptoms  of  any  special  disease, 
exists.  This  is  the  most  common  form  in  which 
bad  air  manifests  its  evil  influence.  And  when  you 
bear  in  mind  the  fact  that  a  wholesome  supply 
of  fresh  air  is  an  absolute  essential  of  healthy  life, 
you  can  easily  comprehend  how  impure  air,  even 
that  which  does  not  contain  the  germ  of  any 
special  disease,  may  produce  this  condition  of  de- 


60  SYMPTOMS   OR   SIGNS    OF    MALARIA. 

pressed  health,  of  lowered  vitality.  So  that  when 
a  person  complains  of  ill  health  it  becomes  neces- 
sary, in  the  first  place,  to  carefully  examine  him  for 
any  special  disease  that  may  give  rise  to  the  symp- 
toms of  which  he  complains.  If  after  a  careful 
and  thorough  examination  all  specific  diseases  are 
excluded,  the  hygienic  conditions  and  surroundings 
of  the  individual  must  be  inquired  into,  and  most 
likely  malaria  or  bad  air,  from  some  cause  or  other, 
will  be  found.  How  many  people  are  there  in  the 
world  who  are  constantly  complaining.  They 
have  no  organic  disease.  They  are  not  confined 
to  the  house,  but  are  able  to  go  about.  They  are 
not  addicted  to  excesses  of  any  kind.  They  do 
not  suffer  from  dyspepsia,  neither  are  they  afflicted 
with  constipation.  They  do  not  absolutely  suffer 
from  headache,  but  are  always  verging  on  that 
condition.  They  do  not  exactly  experience 
nausea,  but  feel  as  though  almost  anything  would 
make  them  vomit.  They  feel  hungry,  and  yet 
when  they  go  to  the  table  an  unconquerable  loath- 
ing for  food,  takes  possession  of  them.  They  feel 
sleepy,  and  yet  when  they  go  to  bed  they  lie 
awake  for  hours.  They  do  nothing .  to  exhaust 
themselves,  yet  are  always  tired.  They  take 
interest  in  nothing.  Their  minds  are  clouded  and 
their  memories  poor.  Such  is  a  description  of  a 
person  afflicted  with  malaria.  If  such  a  person 
lives  in  the  city,  let  him  walk,  ride  or  drive  in  the 


SYMPTOMS    OR   SIGNS   OF   MALARIA.  61 

pure  air  of  a  healthy  country  neighborhood,  and 
immediately  he  feels  better,  the  old  symptoms  re- 
turning, however,  when  he  again  reaches  his  mala- 
rious residence.  So  that  when  one  is  not  in  robust 
health,  yet  has  neither  special  nor  organic  disease, 
but  feels  as  though  (to  put  it  vulgarly)  he  were  only 
half  living,  if  he  can  discover  no  other  cause  for 
this  unfortunate  state  of  affairs,  let  him  look  care- 
fully about  him  and  see  whether  he  be  not  living 
in  a  poisoned  atmosphere.  Let  him  remember  and 
realize  how  many  and  how  unsuspected  may  be 
the  causes  of  this  impure  air,  and  let  him  diligently 
search  for,  and  when  found  remove,  the  particular 
cause  in  his  case.  Let  him  remember  the  various 
causes  for  the  bad  air  I  have  pointed  out ;  let  him  not 
forget  how  profoundly  this  malarious  atmosphere 
may  affect  his  system,  and  let  him  be  ever  mindful 
that  I  have  said  that  the  principal  source  of  this 
impurity  is  organic  decomposition.  I  have  pur- 
posely curtailed  this  chapter  on  the  symptoms  of 
malaria,  for  two  reasons.  First.  Were  I  to  enum- 
erate all  the  symptoms  producible  by  bad  air,  I 
would  be  obliged  to  name  every  sign  of  every 
deviation  from  health,  since,  as  I  have  told  you, 
bad  air,  by  interfering  with  the  healthy  functions 
of  life,  is  capable  of  producing,  at  times,  the  symp- 
toms or  some  of  the  symptoms  of  every  disease. 
This  would  be  confusing,  unintelligible,  and  pro- 
ductive of  no  general  good.  Second.  The  two 


62  SYMPTOMS    OR   SIGNS   OF    MALARIA. 

important  points  for  the  general  public  to  learn 
about  malaria  are,  how  it  is  produced  and  how  it 
can  be  avoided.  Therefore,  with  this  short  hint  at 
the  symptoms,  we  will  close  this  chapter  and  go 
on  to  the  last  and  very  important  one,  "How  to 
avoid  malaria  " 


HOW   TO   AVOID    MALARIA.  63 

CHAPTER  IV. 

HOW   TO   AVOID    MALARIA. 

This  little  book  is  intended  for  intelligent  and 
thinking  people.  It  would  be  impossible  of 
achievement,  and  therefore  useless  to  undertake  in 
so  small  a  volume,  the  exhaustive  discussion  of  any 
subject,  so  I  am  endeavoring  merely  to  give  you 
the  outline,  as  it  were,  of  the  question,  the  details  to 
be  filled  in  by  the  thought  and  reasoning  abilities 
of  the  intelligent  reader.  These  small  popular 
books  on  matters  pertaining  to  health  would  be 
dry,  uninteresting,  unintelligible  and  uninstructive 
reading,  were  all  the  small  details  and  minutiae 
thoroughly  discussed.  They  would  then  partake 
more  of  the  nature  of  medical  text-books,  and 
would  be  interesting  and  instructive  only  to  the 
student  of  medicine.  The  busy  man  of  the  world 
would  not  have  time  to  read  them.  When,  how- 
ever, this  information  is  condensed,  and  the  salient 
points  selected  from  it  given  to  the  public  in  a 
small  volume,  which  can  be  read  in  a  short  time, 
it  will  be  productive  of  much  good.  The  unedu- 
cated and  unintelligent  classes  will  not,  of  course, 
read  these  books;  they  know  nothing  and  care 
nothing  about  the  means  of  preserving  bodily 


4  HOW   TO   AVOID    MALARIA. 

health.  The  intelligent  classes,  who  will  read 
these  books,  do  know  and  do  care  about  health. 
They  value  it,  and  are  anxious  to  preserve  it  to  its 
utmost  limit.  Such  people  are  blessed  with  the 
power  of  reasoning,  and  all  that  is  necessary  is  to 
direct  this  power  into  the  proper  channel.  There- 
fore I  will  point  out  to  you  the  main  indications 
for  the  avoidance  of  malaria,  and  will  give  certain 
hints  which,  aided  by  your  reason,  will  enable  you 
to  avoid  in  every  instance  this  bad  or  malarious 
air.  Let  us  first  look  into  the  city.  Do  not 
occupy  a  house  until  you  have  had  the  whole 
drainage  system  carefully  examined  by  a  thorough- 
ly competent  expert.  If  found  defective,  do  not 
move  into  the  house,  even  though  you  may  get  it 
for  nothing ;  if  you  do  you  will  have  more  than  the 
amount  of  the  rent  to  pay  in  doctors'  bills.  From 
what  I  have  told  you  in  the  second  chapter,  you 
can  understand  that  defective  drainage  is  the  most 
prolific  cause  of  malaria  or  bad  air.  Therefore 
it  is  of  paramount  importance  that  this  matter 
should  be  carefully  attended  to.  If  you  intend 
to  build  a  house,  it  behooves  you  to  employ  only  a 
first-class  plumber  to  do  your  work.  Even  if  you 
are  close  and  mean,  and  desire  to  economize  in 
other  ways,  do  not  begrudge  expense  in  this  di- 
rection. If  you  look  around,  get  many  estimates 
from  different  parties,  and  finally  decide  on  the 
cheapest,  you  may  have  your  foundations,  your 


HOW   TO    AVOID    MALARIA.  65 

brick  work,  your  plastering  and  your  wood  work, 
done  for  very  little  money.  In  a  short  time  the 
defective  workmanship  will  make  itself  known, 
and  you  will  be  put  to  additional  expense  to  have 
it  remedied.  The  only  ill  effects,  however, 
arising  from  this  mistaken  economy  will  be  some 
personal  discomfort  and  an  additional  expense, 
which,  with  the  original  cost,  will  foot  up  a  sum 
greater  than  would  have  been  requisite  to  have 
done  the  work  properly  in  the  first  place.  But 
how  different  it  will  be  with  the  plumbing.  If 
you  look  about  you,  and  get  one  plumber  bidding 
against  another,  you  can,  beyond  doubt,  have  the 
plumbing  of  your  house  done  very  cheaply,  that 
is,  for  a  very  small  sum  of  money,  comparatively 
speaking.  But  if  it  is  imperfectly  done,  the  dam- 
age resulting  cannot  be  measured  by  mere  person- 
al discomfort  or  increased  expense.  Probably  the 
first  intimation  you  may  receive  of  imperfect 
drainage  will  be  when  a  serious  case  of  sickness, 
mayhap  a  fatal  case,  appears  in  your  family.  The 
pipes  and  system  of  drainage  may  be  sufficiently 
complete,  mechanically  speaking,  to  carry  off  all 
the  refuse  from  your  house ;  there  may  be  no  leaks 
and  nothing  prominently  calling  your  attention 
to  defective  drainage.  After  a  while,  maybe,  some 
one  member  of  your  family,  or  even  possibly  the 
majority  or  all  of  them,  may  become  unwell. 
Without  exhibiting  any  definite  symptoms  of  any 


66  HOW   TO   AVOID   MALARIA. 

particular  disease,  they  are  out  of  sorts.  Formerly, 
before  removing  to  your  present  house,  they  have  all 
been  hearty  and  robust.  You  cannot  account  for 
the  change.  They  may  sleep  well  and  yet  awake 
unrefreshed.  They  may  sleep,  and  have  their 
sleep  disturbed  by  hideous  dreams.  They  may 
arise  in  the  morning  with  a  dull,  heavy  feeling  in 
the  head,  a  sense  of  nausea,  a  coated  tongue,  a  bad 
taste  in  the  mouth,  and  a  general  sense  of  lassitude 
and  unrest  altogether  inconsistent  with  a  healthy 
body  after  a  night  of  healthy  sleep.  They  are 
not  sick  enough  to  require  the  doctor,  yet  they  are 
not  well.  They  have  good  appetites,  may  be, 
but  its  full  gratification  distresses  them.  In  a 
word  the  functions  of  life  are  imperfectly  and 
improperly  performed.  The  vital  power  is  de- 
pressed. For  a  long  time  you  speculate  as  to  this 
cause  of  ill-health,  and  reason  and  wonder  in  vain. 
Finally  your  attention  is  directed  to  your  drain- 
age, and  upon  careful  examination  you  find  it  so 
defective  that  great  volumes  of  foul  sewer  gas  are 
allowed  to  enter  the  house,  and,  mingling  with  the 
air  in  your  living  rooms,  to  render  the  atmosphere 
you  use  malarious  or  bad.  Now  will  come  in  the 
extra  expense,  and  I  can  assure  you  that  by  the 
time  you  have  brought  your  plumbing  to  that  de- 
gree of  excellence  necessary  to  render  your  house 
healthy,  you  will  have  spent  very  much  more 
money  than  you  would  have  done  had  your 


HOW   TO   AVOID    MALARIA.  67 

plumbing  been  properly  attended  to  in  the  first 
place.  In  England,  this  question  has  been  con- 
sidered of  sufficient  importance  to  have  had  legal 
enactments  for  its  solution,  and  to-day  the  whole 
of  Great  Britain  is  divided  into  sanitary  districts, 
with  a  medical  officer  of  health  in  each.  This 
officer  is  empowered  by  law,  and  is  obliged,  to  ex- 
amine every  new  building  in  course  of  erection. 
If  it  is  being  constructed  according  to  the  most  ap- 
proved hygienic  rules,  all  is  well ;  if  not,  he  has 
the  authority  to  point  out  in  what  it  is  deficient, 
and  direct  these  defects  to  be  remedied,  possessing 
at  the  same  time  the  necessary  legal  power  to  en- 
force the  fulfillment  of  his  directions.  This  and  other 
sanitary  reforms  in  England  have  been  so  beneficial 
in  their  influence  on  the  life  of  man,  that  within  a  few 
years  the  annual  death  rate  in  that  country  has 
been  reduced  from  about  eighty-four  in  every 
thousand,  to  only  twenty-four  in  every  thousand. 
In  time,  it  is  to  be  hoped  that  we  will  have  such 
beneficial  laws  in  this  country,  compelling  persons, 
against  their  own  foolishness,  to  live  as  they 
should.  At  present  our  people  are  so  busily  oc- 
cupied developing  the  enormous  resources  of  our 
great  country,  that  they  have  but  little  time  to 
bestow  upon  the  preservation  of  health.  But 
when  we  are  more  developed  and  commence  to 
have  leisure  in  which  to  become  cultivated,  our 
attention  will  be  given  more  in  this  direction. 


68  HOW   TO   AVOID   MALARIA. 

In  the  meantime,  it  becomes  the  duty  of  physi- 
cians to  use  all  the  persuasion  of  which  they  are 
capable,  to  induce  people  to  live  in  accordance 
with  the  doctrines  of  hygiene.  To  still  further 
illustrate  the  importance  of  this  point,  I  will 
quote  from  the  Medical  Times  and  Gazette,  of  Eng- 
land, where,  under  the  heading  of  "  Noteworthy/1 
I  find  that  "The  Local  Board  of  Eastbourne  have 
got  a  clause  in  their  Bill,  whereby  they  are  en- 
abled not  only  to  regulate  the  junction  of  house 
drains  with  the  sewer,  but  to  go  inside  the  house 
and  see  that  it  is  constructed  on  sanitary  princi- 
ples, without  which  permission  will  not  be  given 
for  occupation."  As  I  have  already  indicated, 
the  two  great  causes  of  impure  air  in  cities  are, 
ist.  Defective  dramage,  in  its  most  liberal  sense. 
Any  imperfections  that  may  interfere  with  the 
thorough  removal  of  dead  organic  matter,  or 
that  may  allow  the  gases  resulting  from  the  decom- 
position of  this  matter  to  be  returned  to  the  house. 
2d.  Dirty  streets.  To  remedy  this  latter  condition 
comes  in  my  Utopian  plan,  already  referred  to. 
The  most  thorough  sweeping  alone  will  not  and 
cannot  completely  clean  the  streets,  more  particu- 
larly when,  as  in  Philadelphia,  they  are  horribly 
paved  with  rough  and  unsightly  cobbles.  No- 
tice, some  day,  when  the  street  sweepers  are  at 
work  in  your  neighborhood,  what  a  perfect  farce 
their  work  is.  They  sprinkle  the  streets  a  little,  a 


HOW   TO   AVOID    MALARIA.  69 

very  little,  and  then  a  number  of  men  commence 
to  sweep.  In  a  short  time  they  raise  a  tremendous 
dust,  full  of  dead  organic  matter,  which  finds  its 
way  into  the  lungs,  eyes  and  ears  of  passers  by, 
and  is  carried  by  the  wind  hither  and  thither, 
through  open  windows  into  houses,  and  much  of 
it  is  deposited  at  some  point  in  the  street  a  short 
distance  away.  After  a  while,  these  antiquities 
(street  sweepers  are  always  aged  and  decrepit) 
succeed  in  accumulating  piles  of  dirt  along  the 
street.  As  fast  as  built,  they  are  partially  de- 
molished by  the  horses'  feet  and  wheels  of  wagons 
passing  over  them.  In  time,  a  filthy  cart  ap- 
pears, and  what  remains  of  these  dirt  mounds 
is  lifted  on  a  shovel  and  thrown  toward  the 
cart.  Probably  a  goodly  proportion  is  deposited 
in  the  cart,  while  the  balance  falls  back  into 
the  street,  or  is  carried  off  by  the  wind.  When 
the  cleaning  of  a  street  is  finished,  it  is,  of  course 
comparatively  cleaner  than  it  was  before,  but  it  is 
far  from  being  positively  clean.  There  is  sufficient 
dirt,  enough  dead  organic  matter,  to  poison  the 
air  and  render  the  city  unhealthy.  How  can  we 
do  away  with  this  dirt.  I  will  tell  you.  In  the 
first  place,  some  of  the  enormous  sums  of  money 
annually  wasted  by  the  administration  of  our  large 
cities  should  be  utilized  to  largely  increase  the 
water  supply,  the  reservoir  system  of  our  cities,  so 
as  to  make  it  equal  to  the  demand  I  am  presently 


70  HOW   TO   AVOID    MALARIA. 

going  to  make  upon  it.  In  Philadelphia,  a  few  of 
the  millions  foolishly  expended  upon  our  new 
public  buildings  would  suffice  to  give  us  this  in- 
creased water  supply.  As  far  as  possible,  cobble 
paving  should  be  done  away  with,  and  our  streets 
laid  with  a  smooth,  even  pavement  of  some  kind, 
Belgian  block,  Asphalt,  or  the  like.  The  stream 
of  water  from  the  fire  plugs  should  have  sufficient 
pressure  to  throw  it  with  great  force  more  than 
half  across  the  streets.  Every  morning  at  three 
o'clock,  or  thereabouts,  it  should  be  the  duty  of 
every  policeman  to  turn  on  every  fire  plug  in  his 
beat  and  to  let  them  run  with  full  force  until  five 
o'clock,  or  for  two  hours.  Let  us  glance  for  a 
moment  at  the  advantages  of  this  plan.  Every 
morning,  every  single  particle  of  the  decomposing 
organic  material  which  had  accumulated  the  day 
before  would  be  washed  from  the  surface  of  the 
streets,  into  the  sewers.  This  large  and  powerful 
flow  of  water,  rushing  through  the  sewers,  would 
carry  everything  before  it.  This  daily  washing 
out  would  so  purify  and  cleanse  these  previously 
dirty  sewers,  that  sewer  gas  would  be  unheard  of; 
thus  not  only  would  the  streets  be  daily  thoroughly 
cleaned,  but  the  air  of  dwellings  would  be  de- 
prived of  its  most  dangerous  impurity,  sewer  gas. 
This  gas  is  generated  in  sewers  from  the  decom- 
position of  organic  matter  accumulated  therein. 
If  this  matter  were  removed  daily,  and  the  sewers 


HOW   TO    AVOID    MALARIA.  71 

thoroughly  washed  out,  the  production  of  sewer 
gas  would  be  an  impossibility.  The  only  addition- 
al expense  attendant  upon  this  plan  would  be  for 
the  extra  water  supply,  and  this  would  be  infinitely 
more  than  counterbalanced  by  honest  city  gov- 
ernment. Making  the  policemen  turn  on  and 
off  the  water  would  do  away  with  the  necessity 
for  contractors  and  their  antiquated  horde  of 
sweepers.  If,  however,  it  was  considered  necessary, 
for  political  purposes,  that  this  army  of  men  should 
be  supported  by  the  city,  let  me  suggest  a  more 
useful  way  than  the  one  in  which  they  are  at  pres- 
ent employed.  Ten  years  ago,  in  Florence,  Italy, 
I  was  struck  by  the  remarkable  cleanliness  of  the 
streets  in  the  better  portions  of  the  city.  They 
were  laid  in  asphalt,  and  were  immaculate.  I 
was  at  a  loss  at  first  to  account  for  this  great  puri- 
ty, since  horses  and  wagons  were  continually 
passing  to  and  fro.  The  mystery  was  solved 
when  I  met  a  man  walking  in  the  middle  of  the 
street,  with  a  large  hamper-like  basket  strapped  to 
his  back  and  a  shovel  in  his  hand.  Every  particle 
of  horse  manure,  every  piece  of  paper,  in  fact, 
everything  excepting  the  asphalt  pavement  itself, 
was  dexterously  lifted  on  the  shovel  and  deposited 
in  the  basket.  Thus,  with  but  little  trouble 
and  no  attendant  dust,  were  the  streets  of  the  bet- 
ter portion  of  Florence  kept  marvelously  clean. 
With  the  flooding  in  the  early  morning  and  the 


72  HOW   TO   AVOID    MALARIA. 

constant  daily  gathering  of  this  refuse,  dirty 
streets  would  be  impossible,  while  epidemics 
would  be  unheard  of.  How  beautiful,  on  a  bright 
morning,  to  look  out  of  your  window  and  gaze  on 
streets  absolutely  free  from  impurity,  streets  that 
positively  smell  sweet.  Let  me  beg  any  newspaper 
editors  who  may  read  this  book  to  think  over  my 
plan,  and  having  recognized  the  great  good  to  be 
derived  from  it,  to  set  apart  a  space  in  their  papers 
for  the  furtherance  of  this  grand  sanitary  reform. 
Let  them  urge  the  matter  upon  the  attention  of 
the  city  authorities,  and  do  not  rest  until  the 
proposition  is  an  accomplished  fact. 

Dr.  Richardson,  of  London,  a  Sanitarian  of 
eminence,  has  printed  an  address  called  "Jfygeia, 
a  City  of  Health. ' '  There  are  so  many  valuable 
suggestions  contained  in  it,  concerning  our  sub- 
ject, that  I  will  make  a  few  quotations  therefrom. 
He  says,  "The  most  radical  changes  in  the  houses 
of  our  city  are  in  the  chimneys,  the  roofs,  the 
kitchens,  and  their  adjoining  offices.  The  chim- 
neys, arranged  after  the  manner  proposed  by  Mr. 
Spencer  Wells,  are  all  connected  with  central 
shafts,  into  which  the  smoke  is  drawn,  and,  after 
being  passed  through  a  gas  furnace,  to  destroy  the 
free  carbon,  is  discharged,  colorless,  into  the  open 
air."  "  Considering  that  a  third  part  of  the  life 
of  man  is,  or  should  be,  spent  in  sleep,  great  care 
is  taken  with  the  bed-rooms,  so  that  they  shall  be 


HOW    TO    AVOID    MALARIA.  73 

thoroughly  lighted,  roomy  and  ventilated.  Twelve 
hundred  cubic  feet  of  space  is  allowed  for  each 
sleeper,  and  from  the  sleeping  apartments  all  un- 
necessary articles  of  furniture  and  of  dress  are 
rigorously  excluded.  Old  clothes,  old  shoes,  and 
other  offensive  articles  of  the  same  order,  are 
never  permitted  to  have  residence  there. "  "  The 
houses,  being  built  on  arched  subways,  great  con- 
venience exists  for  conveying  sewage  from,  and 
for  conducting  water  and  gas  into,  the  different 
domiciles.  All  pipes  are  conveyed  along  the  sub- 
ways and  enter  each  house  from  beneath.  Thus 
the  mains  of  the  water  pipes  and  the  mains  of  the 
gas  are  within  instant  control  on  the  first  floor  of 
the  building,  and  a  leakage  from  either  can  be  im- 
mediately prevented."  I  could  go  on  thus  for 
pages,  making  interesting  and  valuable  quotations 
from  this  excellent  little  book,  but  instead  of 
doing  so,  I  will  recommend  to  any  one  who  de- 
sires to  build  a  truly  model  house,  from  a  sanitary 
standpoint,  the  careful  study  of  this  little  essay,  en- 
titled "  Hygeia,  a  City  of  Health,"  by  Benjamin 
Ward  Richardson,  M.D.,  F.R.S.  In  addition  to  the 
few  measures  I  have  indicated,  let  me  impress 
strongly  upon  you  what  I  have  already  said,  that 
outside  of  mechanical  impurities,  malarious  or  bad 
air  will  be  produced,  in  the  majority  of  instances, 
by  the  decomposition  of  dead  organic  matter,  and 
since  the  death  of  organic  matter  is  one  of  the 
F 


74  HOW    TO   AVOID    MALARIA. 

necessary  conditions  and  outcomes  of  the  life  of 
the  world,  it  must  always  take  place  and  its  de- 
composition must  ensue,  during  which  process  it 
is  separated  into  its  original  elements,  which  ele- 
ments are  unfit  to  sustain  healthy  animal  life.  So 
that  I  will  make  the  broad  and  sweeping  state- 
ment that,  in  order  to  avoid  malaria,  all  dead  or- 
ganic matter  must  be  removed  from  the  vicinity  of 
man  while  it  is  undergoing  decomposition.  This 
can  be  accomplished  by  attending  to  the  following 
indications.  Perfect  drainage.  Removal  of  ex- 
crement of  all  kind.  Perfect  cleanliness  of  house, 
person  and  clothing.  Free  ventilation.  Abund- 
ance of  sun-light.  Immediate  removal  of  all 
soiled  articles.  Frequent  removal  of  table 
slops,  and  the  limited  use  of  gas,  or  if  freely 
used,  an  abundant  supply  of  oxygen.  I  have 
told  you  that  carbonic  acid  gas,  which  is  produced 
in  so  many  ways,  is  a  very  important  element  of 
atmospheric  impurity.  The  phenomena  of  the  work- 
ings of  nature,  I  must  also  tell  you,  are  very  beauti- 
ful and  very  complete,  and  in  no  instance  is  this 
remarkable  adaptability  of  means  to  ends  more 
perfectly  illustrated  than  in  the  disposition  of  this 
very  carbonic  acid  gas  which  is  so  liberally  pro- 
duced in  nature.  You  now  know  that  this  gas  is 
a  combination  of  carbon  and  oxygen.  The  car- 
bon, I  have  told  you,  is  very  poisonous  to  human 
life,  but  according  to  the  wise  provisions  of  na- 


HOW   TO    AVOID    MALARIA.  75 

ttire  it  is  this  very  article  for  which  vegetable  life 
hungers.  Therefore  trees  immediately  seize  upon 
and  appropriate  this  carbon  to  themselves  and 
turn  loose  the  oxygen,  once  more  pure  and  suited 
to  support  human  life.  So  that  trees  growing  in 
front  of  your  house  are  very  healthy  and  should 
be  encouraged.  They  act  as  scavengers,  they  pu- 
rify the  air.  In  his  model  city,  already  referred 
to,  Dr.  Richardson  says  that  he  would  have  trees 
growing  on  either  side  of  every  street.  Now  to 
the  country.  Here,  of  course,  you  will  have  the 
same  dangers  of  impurity  to  contend  against  as  in 
the  city,  if  you  have  the  same  conveniences. 
Although  the  greater  space  around  your  house  and 
the  lesser  interference  with  the  currents  of  air  will 
dilute  and  render  less  hurtful  these  noxious  ele- 
ments. So  that,  while,  as  I  say,  you  must  be  on 
the  alert  against  these  impurities,  just  as  in  the 
city,  yet  the  greatest  danger  to  be  considered  in 
the  country  is  from  a  naturally  malarious  or  un- 
healthy location.  I  have  already  indicated  what 
localities  ought  to  be  unhealthy.  To  point  this  I 
will  relate  an  actual  case,  which  is  not  by  any 
means  an  isolated  one.  I  had  at  one  time  a  patient 
who  lived  in  a  very  pretty  place  in  the  country. 
But  the  land  was  low  and  the  soil  was  of  heavy 
clay.  His  place  was  lower  than  his  neighbor's, 
all  of  whose  drainage  flowed  from  every  direction 
into  his  ground.  When  it  rained  the  water 


76  HOW    TO   AVOID    MALARIA. 

would  lie  in  pools,  and  in  dry  weather  the  clay 
would  bake  like  bricks.  His  friends  would  come 
to  see  him  and  admire  his  place,  and  comment  on 
the  healthy  appearance  of  his  family,  and  think  he 
was  so  wise  to  live  in  the  pure  country  air.  This 
was  before  the  scenes.  Now  take  a  peep  behind 
them.  The  children  were  apparently  healthy. 
They  were  never  confined  to  bed  by  sickness. 
Neither  his  wife  nor  himself  ever  had  any  serious 
illness  during  their  residence  in  this  place.  Yet 
the  children  were  cross,  peevish  and  fretful ;  their 
appetites  were  fitful  and  erratic  ;  half  the  time  they 
were  exhausted  and  wanted  to  be  nursed.  Their 
sleep  did  not  seem  to  refresh  them.  One  day  they 
would  seem  well  and  hearty,  and  the  succeeding 
one  languid,  petulant  and  feverish,  without  any 
apparent  cause.  His  wife  was  a  constant  sufferer 
from  dyspepsia,  which  persisted  during  her  entire 
residence  in  this  place,  in  spite  of  the  greatest  care 
in  eating  and  varied  medical  treatment.  While 
the  gentleman  himself,  though  never  sick,  but 
young,  strong,  and  ordinarily  robust,  never  felt 
comfortable.  He  was  always  tired,  and  the  slight- 
est exertion  would  produce  great  exhaustion. 
Although  they  both  retired  hardly  ever  later  than 
half  past  nine  or  ten  o'clock,  and  led  the  most 
regular  kind  of  lives,  yet  they  were  always  un- 
comfortable and  depressed.  To  such  an  extent 
did  this  unhealthy  condition  go,  that  the  wife,  in 


HOW   TO    AVOID    MALARIA.  77 

her  despondency,  was  wont  to  exclaim  "  What  is 
the  use  in  living,  if  I  must  feel  so  badly  au  tJie 
time,  AND  so  UNEQUAL  TO  EVERYTHING."  Yet 
apparently  there  was  no  discoverable  cause  for  this 
condition.  Here  was  a  perfect  illustration  of  the 
evil  and  insidious  influences  of  bad  air ;  typical 
cases  of  malaria.  Now  note  what  followed.  This 
gentleman  had  a  relation  living  near  by.  But 
his  location  was  of  the  nature  I  have  described  to 
you  as  naturally  non-malarious.  Occasionally  he 
and  his  wife  would  visit  this  place.  A  wonderful 
and  magical  change  would  occur.  A  hearty  sup- 
per would  not  be  followed  by  dyspepsia.  A 
pleasant  evening  would  be  succeeded  by  a  long 
night  of  sound  sleep,  and  in  the  morning  they 
would  arise  refreshed,  while  a  walk  before  break- 
fast would  be  substituted  for  the  customary  lan- 
guid lolling  around  in  their  malarious  home.  This 
change  occurred  so  frequently  and  so  universally, 
indeed,  there  was  not  one  single  exceptional  in- 
stance, and  the  change  was  so  immediate  and  so 
marked,  that  the  gentleman  commenced  to  think 
that  his  location  could  not  be  a  healthy  one.  He 
commenced  to  investigate,  to  consider,  and  to 
study,  and  finally  concluded  that  his  place  was 
naturally  unhealthy,  that  it  was  malarious.  When 
he  reached  this  conclusion,  he  immediately  moved. 
Like  magic,  the  dyspepsia,  the  malaria,  the  lan- 
gour,  the  inaptitude  for  work,  the  general  oppres- 


78  HOW   TO   AVOID    MALARIA. 

sion,  vanished,  and  they  were  once  more  naturally 
healthy  and  robust  young  persons.  This  is  not 
a  fancy  picture;  it  is  drawn  from  real  life,  and  fur- 
nishes an  excellent  illustration  of  malaria.  I 
have  said  that  this  book  is  intended  for  intelligent 
persons.  Ignorant  people  will  never  derive  any 
benefit  from  such  books,  because  they  cannot 
comprehend  the  points  made.  Were  I  to  enu- 
merate all  the  causes  of  malaria,  and  all  the 
means  recommended  for  its  avoidance,  I  would 
write  for  many  months  and  would  make  a  book 
so  large  and  so  full  of  dry  details  that  very  few  of 
you  would  undertake  to  read  it.  Yet  with  such  a 
large  volume  I  could  not  hope  to  do  as  much  good 
as  with  this  smaller  one.  When  one  endeavors  to 
instruct  intelligent  and  thinking  persons,  it  is 
proper  that  he  should  direct  their  thoughtful  minds 
in  the  proper  channel.  Too  many  small  details 
not  only  insult  this  presumed  intelligence,  but 
render  a  book  so  tiresome  that  it  is  apt  to  be  laid 
aside.  Therefore  it  has  been  my  purpose,  in  pre- 
paring this  small  volume,  merely  to  throw  out 
certain  hints,  to  erect  sign  posts  as  it  were,  which 
would  enable  the  intelligent  man  or  woman  to 
avoid  malaria.  I  do  not  claim  to  have  exhausted 
the  subject,  by  any  means ;  I  have  not  enumerated 
all  the  causes  of,  neither  have  I  mentioned  all  the 
methods  of  avoiding,  malaria.  But  I  have  said 
enough  to  make  you  reflect,  and  this  is  the  true 


HOW    TO   AVOID    MALARIA.  79 

object  of  all  writing.  If  I  have  made  clear  to 
you  the  true  nature  of  malaria,  if  I  have  estab- 
lished my  theory  in  your  mind,  and  if  I  have  di- 
rected your  intelligence  and  your  reasoning  facul- 
ties in  the  right  channel ;  if  I  cause  you  to  reflect,  I 
am  deeply  gratified,  for  then  have  I  fulfilled  my 
purpose  in  undertaking  this  task.  If  my  few 
words  will  cause  you  so  to  act  as  to  diminish  in 
any  degree  the  immensity  of  unnecessary  suffering 
produced  by  malarious  or  bad  air,  my  ambition 
will  be  satisfied,  for  to  do  so  I  have  written  this 
little  book.  Therefore,  asking  you  to  remember 
that  I  am  writing  for  thinking  people,  I  will  con- 
clude what  has  been  to  me  a  very  pleasant  duty, 
summing  up  in  a  few  words  the  substance  of  this 
little  book,  which,  constituting  the  essence,  so  to 
speak  of  all  that  I  have  told  you  in  it,  I  will  beg 
you  to  take  seriously  to  heart,  to  remember,  to 
ponder  over,  to  reflect  about  and  to  act  upon.  Do 
so  and  I  assure  you  we  will  hear  much  less  about 
malaria.  Malaria  means  bad  or  impure  air.  TJiese 
impurities  are  of  various  kinds.  They  consist  of 
any  substances  which  are  injurious  to  the  health  of 
the  human  body.  They  may  be  of  a  mechanical 
character ;  but  are  generally  derived  from  organic 
decomposition.  Everything  that  has  life,  be  it  ani- 
mal or  vegetable,  MUST  DIE.  Everything  that  dies 
MUST  DECOMPOSE,  and  everything  organic  that  de- 
composes MUST  PRODUCE  BAD  AIR,  if  the  resultant 


80  HOW    TO    AVOID    MALARIA. 

products  of  this  decomposition  become  mixed  with 
the  air.  Bad  air  depresses  the  whole  system;  mala- 
ria vitiates  the  body  and  interferes  with  the  healthy 
performance  of  function  of  every  organ.  Its  symp- 
toms are  innumerable,  since  it  may  present  some 
symptoms  of  every  known  disease,  because,  as  each 
specific  disease  will  present  symptoms  referable  to 
some  particular  organ  or  part,  according  to  what- 
ever organ  or  part  may  be  the  seat  of  the  disease, 
and  as  malaria  will  affect  every  organ  or  part  on 
account  of  its  deleterious  action  on  the  whole  system, 
it  may  and  will  offer  symptoms  of  some  disease, 
when  in  reality  such  disease  does  not  exist.  Since 
malaria  is  principally  due  to  organic  decomposition 
and  is  always  produced  by  it,  it  MUST  be  found,  to  a 
greater  or  lesser  extent,  wherever  organic  matter  is 
EXPOSED  to  decomposition,  its  severity  or  mildness 
depending  upon  the  amount  of  such  matter  exposed. 
Since  the  principal  cause  of  malaria  is  organic  de- 
composition, and  since  it  is  one  of  the  inevitable  laws 
of  nature  that  organic  matter  MUST  DECOMPOSE, 
therefore  it  is  self  evident  that  the  surest  way  to 
AVOID  malaria  is  to  remove  this  matter  from  your 
presence  while  it  is  undergoing  decomposition.  You 
now  have  the  question  of  malaria  concisely  placed 
before  you.  Reflect  and  think  about  it.  Use 
your  intelligence  and  your  judgment.  Act  upon 
the  results  of  this  intelligent  reflection,  and  banish 
malaria  from  the  haunts  of  civilization.  In  final 


HOW    TO    AVOID    MALARIA.  81 

conclusion,  one  word  of  wholesome  advice.  If 
you  value  your  health,  do  not  use  quinine  with- 
out medical  advice.  It  is  a  strong  medicine,  po- 
tent for  good  if  properly  used,  and  equally  so  for 
evil  if  improperly  employed.  It  will  cure  Inter- 
mittent Fever,  when  intelligently  administered, 
and  is  useful  in  many  other  conditions  of  ill 
health,  but  on  true  malaria,  such  as  I  have  been 
describing  to  you,  it  will  have  no  good  effect 
whatever  and  may  do  much  harm.  If  you  ask  a 
druggist  about  the  soundness  of  this  view,  he  will 
tell  you  it  is  false,  because  a  large  proportion  of 
his  profit  is  derived  from  the  popular  use  of  qui- 
nine ;  but  any  intelligent,  conscientious  and  un- 
prejudiced physician  will  substantiate  my  state-- 
ment. 


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of  all  classes  may  peruse  it  with  satisfaction  and  advantage."—  Edinburgh 
Medical  Journal. 

DRAINAGE  FOR  HEALTH;  Or,  Easy  Lessons  in  Sanitary 

Science,  with  numerous  Illustrations.    By  Joseph  Wilson,  M.  D.,  Late 

Medical  Director,  United  States  Navy.    One  vol.  Octavo.     Price  $1.00. 

"Dr.  Wilson  is  favorably  known  as  one  of  the  leading  American  writers 

on  hygiene  and  public  health.     The  book  deserves  popularity."— Medical 

and  Surgical  Reporter. 

"Easily  understood,  and  briefly  and  concisely  presented."— Providence 
Journal. 

"  Will  be  sure  to  be  a  harbinger  of  good  In  every  family  whose  good  for- 
tune  it  may  be  to  possess  a  copy."—  Buil der  and  Wood  Worker. 


Presley  Blakiston's 


THE  AMERICAN  HEALTH  PRIMERS.     Edited  by  W.  W. 
Keen,  M.D.    Bound  in  Cloth.    Price  50  cents  each. 
The  Twelve  Volumes,  in  Handsome  Cloth  Box,  $6.00. 

I.  Hearing  and  How  to  Keep  It.  With  illustrations.  By 
Chas.  H.  Burnett,  M.D.,  of  Philadelphia,  Aurist  to  the  Presby- 
terian Hospital,  etc. 

II.  Long  Ufe,  and  How  to  Reach  It.  By  J.  G-.  Richardson, 
M.D.,  ot  Philadelphia,  Professor  of  Hygiene  in  the  University  of 
Pennsylvania. 

III.  The  Summer  and  Its  Diseases.  By  James  C.  Wilson,  M.D., 
of  Philadelphia,  Lecturer  on  Physical  Diagnosis  in  Jefferson 
Medical  College. 

IT.  Eyesight,  and  How  to  Care  for  It.  With  Illustrations. 
By  George  C.  Harlan,  M.D.,  of  Philadelphia,  Surgeon  to  the 
Wills  (Eye)  Hospital. 

V.  The  Throat  and  the  Voice.  With  illustrations.  By  J. 
Solis  Cohen,  M.D.,  of  Philadelphia,  Lecturer  on  Diseases  of  the 
Throat  in  Jeiferson  Medical  College,  etc. 

VI.  The  Winter  and  Its  Dangers.    By  Hamilton  Osgood,  M.T>., 

of  Boston,  Editorial  Staff  Boston  Medical  and  Surgical  Journal. 

VII.  The  Mouth  sind  the  Teeth.    With  illustrations.    By  J.  W. 

White,  M.D.,  D.D.S.,   of   Philadelphia,    Editor   of  the    Dental 

Cosmos. 

VIII.  Brain  Work  and  Overwork.  By  H.  C.  Wood,  Jr.,  M.D., 
of  Philadelphia,  Clinical  Professor  of  Nervous  Diseases  in  the 
University  of  Pennsylvania,  etc. 

IX.  Our  Homes.  With  illustrations.  By  Henry  Hartshorne, 
M.D.,  of  Philadelphia,  formerly  Professor  of  Hygiene  in  the 
University  of  Pennsylvania. 

X.  The  Skin  in  Health  and    Disease.    By  L    D.  Bulkley, 
M.D.,  of  New  York,  Physician  to  the  Skin  Department  of  the 
Demilt  Dispensary  and  of  the  New  York  Hospital. 
XI.  Sea  Air  nntl  Sea  BathJng.    By  John  H.  Packard,  M.D.,  of 

Philadelphia,  Surgeon  to  the  Episcopal  Hospital. 

XII.  School  and  Industrial  Hygiene.  By  D.  F  Lincoln,  M.D., 
of  Boston,  Mass.,  Chairman  Department  of  Health,  American 
Social  Science  Association. 

This  series  of  American  Health  Primers  is  prepared  to  diffuse  as  widely 
and  cheaply  as  possible,  among  all  classes,  a  knowledge  of  the  elementary 
facts  of  Preventive  Medicine,  and  the  bearings  and  applications  of  the 
latest  and  best  researches  in  every  branch  of  Medical  and  Hygienic  Sci- 
ence. They  are  not  intended  (save  incidentally)  to  assist  in  curing  disease, 
but  to  teach  people  how  to  take  care  of  themselves,  their  children,  pupils, 
employe's,  etc. 

They  are  written  from  an  American  standpoint,  with  especial  reference 
to  our  Climate,  Sanitary  Legislation  and  Modes  of  Life;  and  in  these  re- 
spects we  differ  materially  from  other  nations. 


Select  List  of  Books. 


NOTICES  OF    THB  PRESS. 

•*  As  each  little  volume  of  this  series  has  reached  our  hands  we  have 
found  each  in  turn  practical  and  well-written."— New  York  School  Journal. 

44  Each  volume  of  the  4 American  Health  Primers'  The  Inter-Ocean  has  had 
the  pleasure  to  commend.  In  their  practical  teachings,  learning,  and 
sound  sense,  these  volumes  are  worthy  of  all  the  compliments  they  have 
received.  They  teach  what  every  man  and  woman  should  know,  and  yet 
what  nine-tenths  of  the  intelligent  class  are  ignorant  of,  or  at  best,  have  but 
a  smattering  knowledge  of."— Chicago  Inter- Ocean. 

"The  series  of  American  Health  Primers  deserves  hearty  commenda- 
tion. These  handbooks  of  practical  suggestion  are  prepared  by  men  whose 
professional  competence  is  beyond  question,  and,  for  the  most  part,  by 
those  who  have  made  the  subject  treated  the  specific  study  of  their  lives. 
Such  was  the  little  manual  on  'Hearing,'  compiled  by  a  well-known  aurist, 
and  we  now  have  a  companion  treatise,  in  Eyesight  and  How  to  Care  for  It, 
by  Dr.  George  C.  Harlan,  surgeon  to  the  Wills  Eye  Hospital.  The 
author  has  contrived  to  make  his  theine  intelligible  and  even  interesting 
to  the  young  by  a  judicious  avoidance  of  technical  language,  and  the 
occasional  introduction  of  historical  allusion.  His  simple  and  felicitous 
method  of  handling  a  difficult  subject  is  conspicuous  in  the  discussion 
of  the  diverse  optical  defects,  both  congenital  and  acquired,  and 
of  those  injuries  and  diseases  by  which  the  eyesight  may  be  impaired  or  lost. 
We  are  of  the  opinion  that  this  little  work  will  prove  of  special  utility  to 
parents  and  all  persons  intrusted  with  the  care  of  the  eyes."— New  York  Sun. 

44  The  series  of  American  Health  Primers  (now  entirely  completed) 
is  presenting  a  large  body  of  sound  advice  on  various  subjects,  in  a  form 
which  is  at  once  attractive  and  serviceable.  The  several  writers  seem  to 
hit  the  happy  mean  between  the  too  technical  and  the  too  popular.  They 
advise  in  a  general  way,  without  talking  in  such  a  manner  as  to  make  their 
readers  begin  to  feel  their  own  pulses,  or  to  tinker  their  bodies  without 
medical  advice." — Sunday-school  Times. 

44  Brain  Work  and  Overwork,  by  Dr.  H.  O.  Wood,  Clinical  Professor  of 
Nervous  Diseases  in  the  University  of  Pennsylvania,  to  city  people,  will 
prove  the  most  valuable  work  of  the  aeries.  It  gives,  in  a  condensed  and 
practical  form,  just  that  information  which  is  of  such  vital  importance  to 
sedentary  men.  It  treats  the  whole  subject  of  brain  work  and  overwork, 
of  rest,  and  recreation,  and  exercise  in  a  plain  and  practical  way,  and  yet 
with  the  authority  of  thorough  and  scientific  knowledge.  No  man  who 
values  his  health  and  his  working:  power  should  fail  to  supply  himself  with 
this  valuable  little  book."— State  Gazette,  Trenton,  N.J. 

44  An  unexceptional  household  library."— Boston  Journal  of  Chemistry. 

44  Everv  family  should  have  the  entire  series ;  and  every  man,  woman, 
and  child  should  carefully  read  each  book."— Alabama  Baptist. 

WATER  ANALYSIS  For  Sanitary  Purposes,  With  Hints  for 
the  Interpretation  of  Results.    By  E.  FBANKLAND,  PH.D.,  D.O.L.    With 
Illustrations,  Tables,  etc  ,  etc.    12mo.    Cloth.    $1  00. 
••  The  name  of  the  author,  who  is  a  distinguished  Chemist,  and  has  had 
great  experience  in  Sanitary  matters,  is  a  sufficient  testimonial  to  its  ac- 
curacy and  its  great  practical  value."— Boston  Journal  of  Chemistry. 


Presley  Blakiston's 


WHAT  TO  DO  FIRST  in  Accidents  and  Poisoning.  By  Charles 
W.  Dulles,  M.D.  Illustrated.  ISmo.  Cloth.  Price  60  cents. 

PREFACE. 

Whoever  has  seen  how  invaluable,  in  the  presence  of  an  accident,  is  the 
man  or  woman  with  a  cool  head,  a  steady  hand,  and  some  knowledge  of 
what  is  best  to  be  done,  will  not  fail  to  appreciate  the  desirability  of  possess- 
ing these  qualifications.  To  have  them  in  an  emergency  one  must  acquire 
them  before  it  arises,  and  it  is  with  the  hope  of  aiding  any  who  wish  to 
prepare  themselves  for  such  demands  upon  their  own  resources  that  the 
following  suggestions  have  been  put  together. 
OPINIONS. 

"Of  special  practical  value,  and  we  commend  it  to  all."— Lutheran  Ob- 
server. 

44  Ought  to  be  in  everybody's  hands."— Times,  Philadelphia. 

"  Its  usefulness  entitles  it  to  a  wide  and  permanent  circulation."—  Bost on 
Gazette. 

44  Just  the  thing  for  an  emergency."— Portland  Transcript. 

44  Of  great  practical  value  to  the  public."—  Wisconsin  State  Journal. 

"  A  complete  guide  for  sudden  emetgencies." — Philadelphia  Ledger. 

44  So  plain  and  sensible  that  it  ought  to  be  introduced  into  every  female 
seminary." — Evening  Chronicle,  Pittsburgh. 

"The  suggestions  are  of  priceless  value.  "—The  Traveler,  Boston. 

44  The  book  is  invaluable." — Providence  Press. 

EYESIGHT,  GOOD  AND  BAD.  The  Preservation  ofVision. 
By  Robert  Brudenel  Carter,  M.D.,  P.B.O.S.  With  many  explanatory 
illustrations.  12ino.  Cloth.  Price  $1.50. 

PREFACE. 

A  large  portion  of  the  time  of  every  ophthalmia  surgeon  is  occupied,  day 
after  day,  in  repeating  to  successive  patients  precepts  and  injunctions 
which  ought  to  be  universally  known  and  understood.  The  following 
pages  contain  an  endeavor  to  make  these  precepts  and  injunctions,  and 
the  reasons  for  them,  plainly  intelligible  to  those  who  are  most  concerned  in 
their  observance. 

WHAT  IS  THOUGHT  OF  IT. 

"A  very  valuable  book,  and  should  be  in  everybody's  hands."— Nortk 
American. 

44  A  valuable  book  for  all  who  are  interested  in  the  best  use  and  preser- 
vation of  the  vision."-  AT.  E.  Journal  of  Education. 

44  A  compact  volume,  full  of  information  to  all  classes  of  people."—  Book- 
8 filer  and  Stationer. 

t4A  comprehensive  treatise,  well  calculated  to  educate  the  public."— 
Kansas  City  Review. 

44  Q-ives  excellent  advice." — Chicago  Journal. 

44  To  teachers  particularly  the  book  is  of  interest  and  importance."— 
Educational  Weekly. 


Select  List  of  Books. 


HEALTH  AND  HEALTHY  HOMES.  A  Guide  to  Personal 
and  Domestic  Hygiene.  By  George  Wilson,  M.A.,  M.D.,  Medical  Officer 
of  Health.  Edited  by  Jos.  G-.  Richardson,  Professor  of  Hygiene  at  the 
University  of  Pennsylvania.  12mo.  Cloth.  314  pp.  Price  $1.50. 

WHAT  IT  TELLS  ABOUT. 

How  your  Body  is  Made. 

The  Hereditary  Influences,  as  well  as  the  self-Induced  and  Social  causes  of  Dis- 
ease. 

The  Value  and  Choice  of  Food,  its  Preparation,  and  Sensible  Hints  on  Diet. 

Proper  and  well  Adapted  Clothing. 

How  to  take  Exercise,  and  the  best  Method  of  Training. 

Useful  Hints  about  your  Home. 

How  to  Prevent  taking  the  Infectious  Diseases  which  are  always  at  certain  seasons 
so  prevalent  in  cities. 

All  sorts  of  Important  Suggestions  in  Regard  to  the  Everyday  Life. 

WHAT  IS  THOUGHT  OF  IT. 

"  A  most  useful  and,  in  every  way,  acceptable  book."—  N.  York  Herald. 

"Marked  throughout  by  a  sound,  scientific  spirit,  and  an  absence  of  all 
hasty  generalizations,  sweeping  assertions,  and  abuse  of  statistics  in  sup- 
port  of  the  writer's  particular  views.  .  .  .  We  cannot  speak  too 
highly  of  a  work  which  we  have  read  with  entire  satisfaction." — Medical 
Times  and  Gazette. 

"  We  warmly  commend  it  to  the  public."— Boston  Herald. 

"  We  have  read  few  books  of  more  interest  and  value  than  this."—  South' 
ern  Practitioner. 

"  The  book  will  take  a  permanent  position.  It  is  a  sound  work  by  a  com- 
petent  writer."— London  Lancet. 

"  Full  of  good  sense  and  sound  advice."— Educational  Weekly. 

u  The  book  aims  at  the  prevention  of  Disease.  It  abounds  in  sensible 
suggestions,  and  will  prove  a  reliable  guide."— Churchman. 

"  Deserves  wide  and  general  circulation." — Chicago  Tribune. 

WHAT  EVERY  MOTHER  SHOULD  KNOW.  By  Edward 
Ellis,  M.D.,  Author  of  a  Practical  Manual  on  the  Diseases  of  Children. 
16mo.  Cloth.  Price  75  cents. 

14  As  it  is  only  too  true  that  our  children  have  to  dodge  through  the  early 
part  of  life  as  through  a  sort  of  pathological  labyrinth,  we  must  be  thank- 
ful to  meet  with  such  a  sensible  guide  for  them  as  Dr.  Ellis.  He  is  emi- 
nently a  practitioner  among  doctors,  and  a  doctor  among  practitioners ; 
that  is  to  say,  he  is  learned  and  well  knows  what  is  known,  can  do  what 
should  be  done,  and  can  put  what  he  has  to  say  in  plain  and  comprehensive 
language."— Pall  Mall  Gazette. 

"  The  author  has  a  faculty  of  sketching  out  the  characteristics  of  dis- 
eases and  their  treatment  in  striking  outlines,  and  of  making  his  points 
yery  clear  and  im press! ve."— N.  Y.  Medical  Record. 


8  Presley  Blakiston's  Select  List. 

DRUGS  THAT  ENSLAVE.  The  Opium,  Morphine,  Chloral, 
and  Hashisch  Habits.  By  H.  H.  KANE,  M.D.,  of  New  York  City.  One 
volume.  12mo.  With  Illustrations.  Price  $1.50. 

A  curse  that  is  daily  spreading:,  that  is  daily  rejoicing  in  an  increased 
number  of  victims,  that  entangles  in  its  hideous  meshes  euch  great  men  as 
Coleridge,  De  Quincey,  William  Blair,  Robert  Hall,  John  Randolph,  and 
William  Wilberforce,  besides  thousands  of  others  -whose  vice  is  unknown, 
should  demand  a  searching  and  scientific  examination. 

**  A  vivid  and  startling  expose"  of  the  increase  of  this  form  of  intemper- 
ance, and  the  terrible  sufferings  endured  by  those  trying  to  free  them- 
selves  from  this  habit."— Pittsburg  Telegraph. 

"  It  is  well  that  such  a  warning  as  is  contained  in  this  book  should  be 
sounded." — Albany  Evening  Journal. 

"The  volume  seems  to  be  a  summary  of  the  resuUsof  the  most  approved 
practice,  both  in  Europe  and  this  country."— New  York  World. 

"  A  work  of  more  than  ordinary  ability  and  careful  research.  .  .  .  For 
the  first  time,  reliable  statistics  on  the  use  of  chloral  are  classified  and 
published.  .  .  .  And  it  is  shown  that  the  use  of  chloral  causes  a  more 
complete  and  rapid  ruin  of  mind  and  body  than  either  opium  or  morphine." 
— Druggists1  Circular  and  Gazette. 

"  The  effects  of  the  habits  described  are  set  forth  boldly  and  clearly,  and 
the  book  must  have  a  beneficial  effect.  It  will  do  still  better  service  in  de. 
terring  persons  from  experimenting  'to  see  what  it  is  like.' "—  Charleston 
(S.  C.)  Newt  and  Courier. 

"The  subject  of  the  chloral  habit  has  not  been  investigated  by  any  one, 
we  believe,  so  thoroughly  as  by  Dr.  Kane."— Medical  Record. 

"  There  is  ground  tor  a  n-jw  temperance  movement  here.  The  book  is  a 
valuable  one.  It  is  written  in  a  practical  manner,  and  has  nothing  of  a 
sensational  character."— Philadelphia  Ledger. 

THE  OCEAN  AS  A  HEALTH  RESORT.  A  handbook  of 
Practical  Information  as  to  Sea  Voyages,  for  the  use  of  Tourists  and 
Invalids.  By  WM.  S.  WILSON,  L.R.C.P..  Lend  ,  M.R.C.S.E.  With  a 
Chart  showing  the  Ocean  Routes,  and  Illusi  rating  the  Pb/  sical  Geos 
graphy  of  the  Sea.  Crown  8vo.  Price  $2.50. 

Curative  Effects  of  the  Ocean  Climate ;  The  Various  Health  Voyages  ; 
Time  of  Starting;  Choosing  a  Ship;  Preliminary  Arrangements;  Lile  at 
Sea;  Climate  and  Weather;  Management  of  the  Health  at  Sea;  Occupa- 
tions and  Amusements  at  Sea;  Objects  of  Interest  at  Sea  ;  End  of  the 
Voyage;  Future  Plans;  The  Homeward  Voyage;  Australia— Its  Climate, 
Cities  and  Health  Resorts;  South  Africa  and  its  Climate;  The  Meteorol- 
ogy of  theOcean.  Appendix  A.— Outfit  Required  for  a  Voyage  to  Austra- 
lia. Appendix  B.-— Names  and  Addresses  of  some  of  the  Principal  Ship- 
ping Firms. 

"All  the  information  is  supplied  by,  or  based  upon,  the  actual  experience 
of  the  author ;  and  the  book  may  be  confidently  recommended  to  all  who 
have  to  undertake,  without  previous  experience,  a  sea  voyage  of  any 
length.  Medical  men  may  consult  it  with  advantage,  and  commend  it  to 
those  patients  whom  they  may  advise  to  try  the  effect  of  a  long  voyage  at 
sea"—  Med.  Times  and  Gazette. 

"  We  have  read  every  page  of  this  book,  and  have  derived  both  instruc- 
tion and  amusement."— Lancet. 


